Mrs. Smith's eyes filled with tears as she said, “I feel like I've done something wrong. Are they punishing me because I've been refusing therapy and won't go to a nursing home?” She acknowledged that she hadn't always listened to her doctors but said that she knew better now and wanted to go home and see if she could make it work. Many staff members at our rehabilitation hospital had explained their safety concerns to her, and some had enlisted her (...) adult daughter, with whom she lived, to convince her too. The rehabilitation team had called on the ethics consultation service, of which I am a part, to help figure out whether Mrs. Smith had the capacity to make an informed refusal of discharge recommendations. (shrink)

Dignity of risk is a simple concept that is surprisingly hard to enact, honor, and prioritize in health care. The term was coined 50 years ago by Robert Perske in an article entitled "The Dignity of Risk and the Mentally Retarded". And as I have written in "Discharge Decisions and the Dignity of Risk", "the concept involves respect for persons, self-determination, and attempts to minimize paternalism or parentalism". Most simply, the dignity of (...) class='Hi'>risk embraces respecting or honoring an individual's choices or decisions even in the face of potential harms.The central tension between safety/protection and autonomy/self-determination is at the core of the concept, but it also involves appraisals... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind (...) the Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

Healthcare robots enable practices that seemed far-fetched in the past. Robots might be the solution to bridge the loneliness that the elderly often experience; they may help wheelchair users walk again, or may help navigate the blind. European Institutions, however, acknowledge that human contact is an essential aspect of personal care and that the insertion of robots could dehumanize caring practices. Such instances of human–robot interactions raise the question to what extent the use and development of robots for healthcare applications (...) can challenge the dignity of users. In this article, therefore, we explore how different robot applications in the healthcare domain support individuals in achieving ‘dignity’ or pressure it. We argue that since healthcare robot applications are novel, their associated risks and impacts may be unprecedented and unknown, thus triggering the need for a conceptual instrument that is binding and remains flexible at the same time. In this respect, as safety rules and data protection are often criticized to lack flexibility, and technology ethics to lack enforceability, we suggest human dignity as the overarching governance instrument for robotics, which is the inviolable value upon which all fundamental rights are grounded. (shrink)

We draw on the concept of dignity to consider the ethics of the disposal of amputated limbs. The ethics of the management and disposal of human tissue has been subject to greater scrutiny and discussion in recent years, although the disposal of the limbs often remains absent from such discourses. In light of the recent UK controversy regarding failures in the medical waste disposal and the stockpiling of waste, the appropriate handling of human tissue has been subject to further (...) scrutiny. Although this scandal has evoked concern regarding procurement and supply chain issues, as well as possible health and safety risks from such a ‘stockpile’, the dignity of those patients’ implicated in this controversy has been less widely discussed. Drawing at Foster’s work, we argue that a dignity framework provides a useful lens to frame consideration of the disposal of limbs after amputation. Such a framework may be difficult to reconcile with the logic of business and the ‘biovalue’ of the medical waste, but would we argue afford more patient-centred approaches towards disposal. It may also facilitate better practices to help mitigate future stockpiling incidences. (shrink)

The concept of ‘human dignity’ sits at the heart of international human rights law and a growing number of national constitutions and yet its meaning is heavily contested and contingent. I aim to supplement the theoretical literature on dignity by providing an empirical study of how the concept is used in the specific context of legal discourse on sex work. I will analyse jurisprudence in which commercial sex was declared as incompatible with human dignity, focussing on the (...) South African Constitutional Court case of S v Jordan and the Indian Supreme Court case of Budhadev Karmaskar v State of West Bengal. I will consider how these courts conceptualise dignity and argue that their conclusions on the undignified nature of sex work are predicated on particular sexual norms that privilege emotional and relational intimacy. In light of the stigma faced by sex workers I will explore how a discourse, proclaiming sex work as beneath human dignity, may impact on the way that sex workers are perceived and represented culturally, arguing that it reinforces stigma. I will go on to examine how sex workers subvert the notion that commercial sex is undignified, and resist stigma, by campaigning for the right to sell sex with dignity. I will demonstrate that an alternative legal approach to dignity and sex work is possible, where the two are not considered as inherently incompatible, concluding with thoughts on the risks and benefits of using ‘dignity talk’ in activism and campaigns for sex work law reform. (shrink)

Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, (...) by treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer. (shrink)

This essay answers two questions that continue to drive debate in moral and legal philosophy; namely, ‘Is a risk of harm a wrong?’ and ‘Is a risk of harm a harm?’. The essay’s central claim is that to risk harm can be both to wrong and to harm. This stands in contrast to the respective positions of Heidi Hurd and Stephen Perry, whose views represent prominent extremes in this debate about risks. The essay shows that there is (...) at least one category of risks – intentional impositions of risk on unconsenting agents – which can be both wrongful and harmful. The wrongfulness of these risks can be established when, on the balance of reasons, one ought not to impose them. The harmfulness of these risks can be established when the risks are shown to set back legitimate interests. In those cases where risks constitute a denial of the moral status of agents, risks set back agents’ interest in dignity. In these ways, the essay shows that there are instances when a risk can constitute both a wrong and a harm. (shrink)

Bioethics is a field of inquiry and as such is fundamentally an epistemic discipline. Knowing how we make moral judgments can bring into relief why certain arguments on various bioethical issues appear plausible to one side and obviously false to the other. Uncertain Bioethicsmakes a significant and distinctive contribution to the bioethics literature by culling the insights from contemporary moral psychology to highlight the epistemic pitfalls and distorting influences on our apprehension of value. Stephen Napier also incorporates research from epistemology (...) addressing pragmatic encroachment and the significance of peer disagreement to justify what he refers to as epistemic diffidence when one is considering harming or killing human beings. Napier extends these developments to the traditional bioethical notion of dignity and argues that beliefs subject to epistemic diffidence should not be acted upon. He proceeds to apply this framework to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision-making for patients in a minimally conscious state, and risky research on competent human subjects. to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision-making for patients in a minimally conscious state, and risky research on competent human subjects. (shrink)

The purpose of this paper is to explore the visual representation of dignity, through the particular example of the seventeenth century Spanish painter Diego Velázquez. Velázquez works at a point in Western history when modern conceptions of dignity are beginning to be formed. It is argued that Velázquez' portraits of royalty and aristocracy articulate a tension between a feudal conception of majesty and a modern conception of the dignity of merit. On this level, modern conceptions of (...) class='Hi'>dignity of merit are understood in terms of a struggle to excel in particular activities, and thus to overcome the risk of failure. More radically, Velázquez' portraits of dwarfs and the mentally disabled are argued to be expressive of dignity, not by finding a positive representation of the sitter's dignity, or to find scales of activities by which they can be positively assessed, but rather by grounding their dignity, negatively, in a protest against indignity and humiliation. Drawing on Honneth's analysis of dignity in terms of a theory of recognition, it is argued that the indignity of the court dwarf lies in the fracturing of their communication with the rest of society. The task of repairing that fractured communication is achieved, not by representing a dignified ideal, but rather by drawing attention to the prejudices that serve to exclude the humiliated from full participation in society. In conclusion, it is suggested that the conceptualisation and representation of the elderly today finds effective exemplars in Velázquez' portraits of court dwarfs, rather than in his portraits of the elderly. (shrink)

Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the (...) practice of respect and protection from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient’s dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient’s wishes and needs are the starting point. (shrink)

Pregnant women are insistently urged to limit or eliminate risks to their fetuses. This is done even when the risks to fetuses are only theoretical or minimal, and the health and well-being of the pregnant woman is at stake. When using reproductive and reprogenetic technologies, however, evaluations about what risks are acceptable to impose on embryos change radically. In the context of these technologies, women are not only allowed to impose risks on embryos, but actively encouraged to do so-insofar as (...) they can be urged to use these technologies for various reasons. This article explores the problematic beliefs and social norms regarding motherhood that shape these apparently inconsistent risk evaluations. (shrink)

Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer’s disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the (...) increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL). Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD. Research Design: We conducted a concept analysis using Walker and Avant’s eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords “dignity,” “dementia,” “Alzheimer’s disease,” and “dementia care.” Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person’s sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced. Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be developed, (...) used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

This response to Kariyawasam and Rai affirms their critique of the pathologization of trans youth but forecasts a foreseeable negative outcome of their proposed elimination of diagnosis as a prerequisite to gender-affirming care (GAC) — the risk of removing GAC entirely from the medical sphere and compromising the wellbeing of those transgender individuals for whom GAC is deeply affirming. We suggest an ethical framework of GAC that expands past a focus on autonomy to incorporate a principle of respect for (...) persons that affirms the dignity and diversity of trans youth — recognizing the need to facilitate both medical assistance and social change. (shrink)

This paper focuses on a distinct puzzle for understanding the relationship between dignity and human rights. The puzzle is that dignity appears to enter human rights theory in two distinct roles: on the one hand, dignity is commonly pointed to as the foundation of human rights, i.e. that in virtue of which we have human rights. On the other hand, dignity is commonly pointed to as that which is at risk in a subset of human (...) rights, paradigmatically torture. But how can dignity underpin all human rights, and yet only be at stake in very specific human rights violations? And if dignity is lost in torture, how can the tortured retain their human rights? In this paper I offer a solution to these puzzles, in the form of a new theory of dignity. On this new theory, an individual’s dignity can be constituted via either of two pathways: the agent’s own normative competencies, or the authority of her community. The former is what’s typically at stake in practices such as torture; it in virtue of the latter that we have human rights. (shrink)

In this chapter the explanatory value of four conceptions of human dignity to account for two seemingly contradictory intuitions is tested. One is that many people think poverty violates the humanity of poor people. The other intuition is that poor people often act with remarkable dignity despite their trying circumstances. First Immanuel Kant’s influential view on human dignity that claims it is grounded in humans’ capability to make moral judgments is examined. Next, Martha Nussbaum’s theory of the (...) capability approach is tested, which is hugely influential across many academic disciplines and in the world of economic development. Thereafter, two related, though distinctly different African theories of human dignity, as offered by Thaddeus Metz and Polycarp Ikuenobe are assessed. Both base their theories on the core capacity of humans to engage in harmonious relationships within communities. Last, it is investigated the theory that Avishai Margalit provides of honour and humiliation as concepts that illuminate the value and risks for humans’ possession of dignity. His theory is linked to aspects of the recognition theory of Axel Honneth. In the end, it is concluded that these theories either cannot fully, or adequately, explain the complex relationship between poverty and human dignity. (shrink)

ABSTRACT:Promoting dignity is at the heart of the human capability approach to development. We introduce the concept of stakeholder capability enhancement, beginning with a discussion of the capability approach to development proposed by Sen (1985) and further advanced by Nussbaum (1990) to incorporate notions of dignity. Thereafter follows a review of the literature on value creation stakeholder management and convergent stakeholder theory (Freeman, 1984; Freeman, Harrison, Wicks, Palmer, & DeColle, 2010; Harrison & Wicks, 2013; Jones & Wicks, 1999), (...) as the foundation for our concept of stakeholder capability enhancement. The remainder of this article develops a model that integrates stakeholder management with the human capability approach to detail the cooperative advantage that accrues to business and its stakeholders, as well as the gains in social wellbeing and dignity, when stakeholder capability enhancement becomes a common enterprise strategy. The model also explores the risks and boundary conditions firms face when seeking to profit from stakeholder capability tradeoffs. In explaining the model, we explore normative responsibilities and consequences with regard to human capabilities and dignity. We conclude with implications for future research. (shrink)

Although much theoretical and empirical research has examined organizational power, virtually none has addressed the hierarchical abuse of power in organizations. Managers' incentives and discretion and subordinates' dependencies define the abuse of power as an important organizational issue. This paper offers a conceptualization and process model to help further theoretical and applied understanding, and it considers the ethical nature of power abuse. Two dimensions, disrespect for individual dignity and interference with job performance or deserved rewards, conceptualize the interpersonal abuse (...) of power. Behavioral examples of each dimension are provided.The process model delineates powerholders' motives to abuse power and indicates individual attributes that increase the probability of their pur-suing these motives. Organizational conditions that allow or encourage the abuse of power and managers' particular sources of power interact with these motives and attributes to define decisions about abusing power. Norms and considerations of risk influence these decisions. The decision to abuse power leads to the enactment of power strategies, and they generate intended and unintended outcomes. The process model presented here recognizes an emotional component of the hierarchical abuse of power. (shrink)

In ‘Patients, doctors and risk attitudes,’ Makins argues for ‘straightforwardly’ (Makins1 p1) extending antipaternalistic views about medical decision-making to include deferential considerations of risk attitudes that a patient might endorse. Reflecting on Makins’ important contribution to higher order attitudes in decision theory, we seek to clarify the practical applicability of his argument to specific clinical settings, namely in mental health. We argue that considering low and higher order risk preferences are not only practically difficult, but also potentially (...) ethically fraught and especially so in the provision of mental healthcare. Deferring to risk attitudes potentially mutes a more robust curiosity of patients’ preferences and desires that can promote both autonomy and beneficence but are explicitly relationally grounded. We argue that a relational understanding of autonomy is a much more robust way of thinking about the value of risk attitudes among other patient preferences, attitudes and goals. Makins rightly expounds on the challenges faced by healthcare professionals who are often required to make determinative recommendations for their patients. Providers must explain uncertain benefits in relation to uncertain risks, therefore, exploring the risk attitudes of patients, appears, prima facie, a rational, patient-centred and autonomy-promoting choice. It invariably invites discussion of Perske’s 1972 dignity of …. (shrink)

One argument Robert and Baylis do not raise in their article on the creation of interspecies chimeras using human cellular material is that the creation of these chimeras would, or could, offend human dignity. Yet, human dignity is one of the most common concerns raised in public debates, academic arguments, and policy documents regarding biotechnology in general, and the creation animal-human chimeras in particular. … The concept is ill-defined within bioethics and … risks being dismissed as meaningless or (...) uselessly vague. However, this lack of definition should not yet cause us to abandon or ignore human dignity. At least in arguments about creating chimeras, an examination of what may be meant by appeals to human dignity can uncover important concerns or arguments that are not captured by other formulations of the debate. (shrink)

BackgroundCommunity engagement within biomedical research is broadly defined as a collaborative relationship between a research team and a group of individuals targeted for research. A Community Advisory Board is one mechanism of engaging the community. Within genomics research CABs may be particularly relevant due to the potential implications of research findings drawn from individual participants on the larger communities they represent. Within such research, CABs seek to meet instrumental goals such as protecting research participants and their community from research-related risks, (...) as well as intrinsic goals such as promoting the respect of participants and their community. However, successful community engagement depends on the degree to which CABs legitimately represent and engage with communities targeted for research. Currently, there is little literature describing the use of CABs in genomics research taking place in developing countries, and even less in the field of genomics research relating to mental illness. The aim of this article is to describe and consider the contributions made by a researcher-driven, population-specific CAB in a genomics of schizophrenia research project taking place in South Africa, from the perspective of the research team.DiscussionFour broad discussion topics emerged during the CAB meetings namely: 1) informed consent procedures, 2) recruitment strategies, 3) patient illness beliefs and stigma experiences, and 4) specific ethical concerns relating to the project. The authors consider these discussions in terms of their contributions to instrumental and intrinsic goals of community engagement.SummaryThe CAB gave valuable input on the consent processes and materials, recruitment strategies and suggested ways of minimizing the potential for stigma and discrimination. All of these contributions were of an instrumental nature, and helped improve the way in which the research took place. In addition, and perhaps more importantly, the CAB made a unique and important contribution relating to intrinsic functions such as promoting the respect and dignity of research participants and their community. This was particularly evident in ensuring sensitivity and respect of the community’s traditional beliefs about schizophrenia and its treatment, and in this way promoting a respectful relationship between the research team and the participants. (shrink)

This article assembles reasons for holding that the propaedeutic rationale for much of the discourse produced by ‘ethogenic science’ is inadequate. One reason is that the interactional principles that are the pretext for assembling the situational vignettes, which are the staple of ethogenics, are truisms and do not require documentation. Our familiarity with the risks and rewards of social life is already considerable and it is not clear how, or to what end, ethogenic science can augment them. Moreover ethogenic theorists (...) do not explain how a discipline that eschews experiment and causal inquiry can transcend the understanding of the subject and how, if it does not, it can do more than provide perspicuous views of the social facts and practices already known, or at least within reach of unspecialized observation. The programme of uncovering the mechanisms by which we register and evince our social standing is not one of which we are given a coherent account and is, in any case, not to be served by multiplying examples of how respect and contempt are merited or meted out. It is suggested that the need such discourse surreptiously meets is that of an autonomous craving for Wittgensteinian Übersichten - overviews - of the vicissitudes of social existence. (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)

This article introduces the concept of technological citizenship as a status for individuals consisting of rights and obligations within bounded technological polities enforced by statist structures. The model reconciles freedom to innovate with the affirmation of the autonomy and dignity of laypersons and the assimilation of laypersons with their world. It seeks lay control over the introduction and ongoing management of environmental hazards and self-verification of safety. The rights and obligations of TC compose a "new social contract of complexity." (...) Even with different values stressed, the name, concept, and terms of TC would streamline studies of peril. (shrink)

Excerpt: 1. Introduction This chapter provides insight into the diverse ethical debates on genetics and epigenetics. Much controversy surrounds debates about intervening into the germline genome of human embryos, with catchwords such as genome editing, designer baby, and CRISPR/Cas. The idea that it is possible to design a child according to one’s personal preferences is, however, a quite distorted view of what is actually possible with new gene technologies and gene therapies. These are much more limited than the editing and (...) design metaphors suggest. Such metaphors are therefore highly problematic phrases in the context of new gene technologies, for two reasons. On one hand, to design a child of choice by modifying the genome would require modifying any gene of choice, which is more than can be done with current gene technologies, such as CRISPR/Cas. On the other hand, a modification of genes would need to be enough to create any characteristic of choice in the future child. The latter presupposes the assumption of genetic determinism. Moreover, the CRISPR/Cas technology can not only be used in a potentially therapeutic manner at the germline level. In addition, there is the (more likely) scenario of a future clinical therapeutic use of these new gene technologies for modifying the DNA sequence of other cells of the body (somatic genome editing). There is also the option of modifying the epigenome, that is, the spatial configuration of DNA (epigenome editing) (see table 1). Like genetics and genome editing, epigenetics has been at the center of recent popular scientific and ethical discourse as well as scientific debates. The concept of epigenetics has given rise to very different notions of inheritability and responsibility for health, which, however, are oftentimes based on scientifically controversial basic assumptions. That there continues to be covert genetic determinism in the form of epigenetic determinism (see table 2) in debates about epigenetics has been pointed out in ethical analyses of epigenetics. Neither genetic determinism nor epigenetic determinism has been confirmed scientifically. It is therefore important to recognize the concepts that are discussed (and sometimes harshly criticized) in debates about genome editing and epigenetics—for example, concepts about the causal role of DNA for our own life course. This importance is based on the fact that if we understand such controversial concepts, we will be able to remain critical when evaluating scientific knowledge and ethical arguments about genome editing and epigenetics. This chapter, therefore, explains some of these concepts. For an ethical analysis of epigenetics as well as of genome editing, it is necessary to understand and critically reflect upon the underlying concepts of genetic determinism and other, related -isms. The following section offers a detailed introduction to these -isms (section 2; see also table 2). Section 3 provides an ethical analysis of genome editing and epigenetics based on the explanations in section 2. Section 3 focuses on inheritability and responsibility, justice, safety, the problem of consent, and the effects of genome editing and epigenetics on embryos and future generations. This section does not discuss in detail further points that can be found in ethical debates about epigenetics as well as in ethical debates about genome editing. These points include (among others): • fear that the findings of epigenetics and that the methods of genome editing are misused—this also with respect to eugenics and enhancement; • naturalness—an issue we mention in passing a few times in the following analysis; • a possible connection between the genome/epigenome and the concept of human dignity, and the derived danger of instrumentalization and infringement of autonomy when intervening in the genome or epigenome. Since current discourse about ethical issues associated with genome editing focuses mainly on germline interventions, which are, for instance, interventions into a human embryo’s genome, we mainly focus on germline interventions when comparing the debates on genome editing and on epigenetics in section 3. (shrink)

The idea that there is a fundamental difference in value between persons and things, and that respecting this difference is an important moral requirement, has strong intuitive appeal. Kantian ethics is unique in placing this requirement at the center of a moral system and in explicating the conditions for complying with it. Unlike challenges to Kantian ethics that focus on tragic cases that pit respect for one person against respect for another, this paper focuses on the question of how we (...) can respect the value distinction between persons and things under conditions of uncertainty. After exploring why decision making under uncertainty is a neglected topic among Kantians and demonstrating how uncertainty challenges our ability to comply with this norm, we propose a notion of morally insignificant risk within a framework that allows agents to navigate real-world decisions involving material benefit and some risk to dignity without violating the Kantian’s core commitments. We conclude by exploring some of the challenges facing this approach. (shrink)

Individuals in capitalist societies are increasingly exposed to market risks. Luck egalitarian theories, which advocate neutralizing the influence of luck on distribution, fail to cope with this problem, because they focus on the wrong kinds of distributive constraints. Rules of distributive justice can specify (1) acceptable procedures for allocating goods, (2) the range of acceptable variations in distributive outcomes, or (3) which individuals should have which goods, according to individual characteristics such as desert or need. Desert-catering luck egalitarians offer rules (...) of the third type. Their theories fail because considerations of market efficiency, freedom, and dignity undermine the claims of desert to inform standards of justice for society as a whole. Responsibility-catering luck egalitarians offer rules of the first type. Their theories fail because such rules don’t constrain the downside risks of market choices. To solve this problem, we need rules of the second type, which allow market forces, and hence luck, to influence distributive outcomes, but only within an acceptable egalitarian range. The ideal of equality in social relations helps us devise acceptable constraints at the top, bottom, and middle of the income range. (shrink)

Some have objected to the laboratory cloning of human preembryos on the grounds that the procedure would violate the dignity of and respect owed to human preembryos. Others have argued that human cloning ought be permitted if it will predictably benefit, or at least not burden, individuals who are, unlike the human preembryo, clearly entitled to our respect and concern. Taking this latter position, the legal theorist John A. Robertson has argued that, since cloning does not harm anyone who (...) is clearly entitled to our respect and concern, it should be permitted. In particular, the offspring of cloning, he argues, cannot be genuinely harmed by cloning, since they owe their very existence to the cloning procedure. In this paper, I argue that cloning coupled with its related procedures does in fact place the flesh and blood human offspring of cloning at risk of genuine harm. I thus provide a basis for questioning the moral permissibility of cloning and its related technologies without implying that the human preembryo has dignity or is owed respect. (shrink)

I argue that the consumption of illegally shared pornography is often morally problematic. My argument is not based on any general condemnation of pornography or even illegal content sharing as such. Instead, my argument emphasizes that commercial pornography that is illegally shared risks violating the consent and thus the dignity of its performers. In this way, illegally shared pornography is akin to ‘revenge porn’, involving the non-consensual distribution and consumption of sexually intimate images or videos. The idea is that (...) if viewing sexually explicit content shared without the permission of the people featured within it is unethical, then the same is often true of the consumption of commercial pornographic content that has been shared illegally. My primary focus is on the commercial pornography produced and distributed by the performers themselves, but I also consider the moral status of more traditional forms of pornographic content. (shrink)

A multitude of legislation impacts the use of samples and data for research in South Africa. With the coming into effect of the Protection of Personal Information Act No. 4 of 2013 in July 2021, recent attention has been given to safeguarding research participants’ personal information. The protection of participants’ privacy in research is essential, but it is not the only risk at stake in the use and sharing of personal information. Other rights and interests that must also be (...) considered and safeguarded include the right to non-discrimination, the right to dignity, and the right to enjoy the benefits of scientific progress. This can be achieved by ensuring that the ethical values and universal principles that underpin the research landscape, namely equity, reciprocity, justice and solidarity, are embedded in the regulatory framework for the management and use of personal information. This paper advocates an integrated bioethics approach to the use of personal information for research in SA. A key feature in embedding such an approach is a Data Transfer Agreement that appropriately integrates the safeguards and protections set out by our regulatory framework with bioethical rules and procedures when personal information is used and shared for research purposes. This paper thus calls for the development of a national DTA that is guided by key ethical principles when data are shared for research purposes. This paper will be followed by a webinar on 23 June 2022 hosted by the Department of Science and Innovation and the SA Medical Research Council, where the recommendations and suggestions set out herein will be unpacked, discussed and debated by relevant stakeholders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:TRANSCENDENT MAN IN THE LIMITED CITY: THE POLITICAL PHILOSOPHY OF CHARLES N. R. McCOY ]AMES v. SCHALL, S.J. Georgetown University Washington, D. C. The history of political philosophy since the time of St. Thomas has been a history of successive failures to relate ethics to politics and of successive attempts to find a substitute for theology, either in politics itself... or in economics.... Men are today oppressed by false (...) theologies erected into political systems, and those who are not so oppressed are in risk of becoming so oppressed by an intellectual and moral inability to defend themselves. St. Thomas's political science will not give us the answers to problems of hydro-electric development or technological unemployment ; but it will give us the answer to the most vital of contemporary problems: how to secure the rational foundations of humane living. -Charles N. R. McCoy," St. Thomas and Political Science." 1 I IN WRITING ABOUT the small but rich corpus in political philosophy by Charles N. R. McCoy, the temptation is almost irresistible to call it, wittily, " The Real McCoy," or, more academically, a theoretic essay on the reasons for our " intellectual and moral inability to defend ourselves." The kind of being we are, no doubt, needs defense, needs an explication that justifies its unique givenness. Charles N. R. McCoy is not generally wellknown, though he has a small and (one hopes) growing number of admirers. The very cultural unlikelihood of his central theme, 1 On the Intelligibility of Political Philosophy: Essays of Charles N. R. McCoy, edited by James V. Schall, S.J. and John J. Schrems (Washington: Catholic University of America Press, 1989), p. 38. 63 64 JAMES V. SCHALL, S.J. which 1s m no sense Hegelian, that there is indeed a coherent philosophical intelligibility-a "structure "-to political philosophy, makes his work both unique, profoundly appealing, and perhaps even prophetic. McCoy was concerned to explain the transcendence of each person, each citizen, beyond the city, indeed beyond this world, without denying his exact political nature and the reasons for its limits. Man was both a political and a philosophical animal to whom more than either politics or philosophy was given. The dignity of the city was essentially revealed in its limits, in what good it could do with its own means while leaving other admitted goods untouched, in what questions it could legitimately bring up because of its experienced life, but still could not answer by itself. On reading him carefully in one's own pursuit of philosophic wisdom in an age replete with sundry mental and moral confusions, it is tempting to affirm that, at last, in political philosophy here is found a body of reflection which is indeed " the real McCoy." Here is a consistent examination of philosophic principle that accounts for the contours of the whole of the discipline in its most radical origins and clearest limits. McCoy's "reality" does not, to be sure, exist for most of the political science profession itself nor for Christian thinkers in the field of political thought. This situation is unfortunate on both counts. Political philosophy, for its part, has pursued in modern times the line of its own autonomy in rejecting the great tradition which affirmed the limited place of politics in the order of being, its position as a practical, not speculative science. Theology-itself seeking relevance in lieu of transcendence-has largely imitated this modern turn in political thought. The crisis in theology is, more than anything else, the result of a crisis in political philosophy, its evolution in modernity. Thus in a discipline in which so many of the ultimate human issues are either not confronted at all or are at best confused, in a theological environment which is itself largely infected with the theoretical deviations McCoy chronicled, this benign neglect of his work may turn out to be an advantage. McCoy's independence of these ideological movements, grounded POLITICAL PHILOSOPHY OF CHARLES N. R. MC COY 65 as it is in the philosophical tradition from which these movements systematically deviated, provides a new and fresh way of coming to terms with the meaning of political philosophy itself. In a spirit of... (shrink)

Much of the writing of and about the twelfth-century rabbi, philosopher, and theologian Moses Maimonides is addressed to an elite audience of philosophers and intellectuals. Here, Ralph Lerner's exploration of Maimonides' popular writings reveals that the education of the common man was one of the great teacher's chief concerns. Lerner describes the brilliant and sometimes wily ways in which Maimonides sought to break through the despair and superstition that gripped the Jewish people's minds, without sacrificing the dignity and core (...) of his message. These writings—presented here in uncommonly accurate, mostly new translations—also reveal that Maimonides was willing to risk the scorn of his contemporaries to enlighten both his own and future generations. By addressing the writings of Maimonides' disciples, including Shem Tov ben Joseph Ibn Falaquera in the mid-thirteenth century and Joseph Albo in the fifteenth century, Lerner shows how this technique was passed on. In striking contrast to the Enlightenment of the eighteenth century, Maimonides' enlightenment is premised on the inequality of understandings and other differences between the elite and the common people. Instead of scorning the past, Lerner shows, Maimonides' enlightenment invests it with a new and ennobling dignity. A valuable reference for students of political philosophy and Jewish studies, Lerner's elegantly written book also brings to life the richness and relevance of medieval Jewish thought for all those interested in the Jewish tradition. (shrink)

Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties in eldercare, such (...) as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol‐related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma. (shrink)

An influential critique of anger holds that anger comes at an important epistemic cost. In particular, feeling angry typically makes risk less visible to us. This is anger’s ‘red mist.’ These epistemic costs, critics suggest, arguably outweigh the epistemic benefits commonly ascribed to anger. This essay argues that the epistemic critique of anger is importantly misleading. This is not because it underestimates anger’s epistemic benefits, but rather because it overlooks the fact that anger’s red mist performs a crucial moral (...) function. By concealing risk, the red mist helps protect the dignity and self-respect of those who live under severe and unchosen risk. This function is vitally important in non-ideal circumstances, where many are unjustly subjected to dignity-impairing risk. And it is irreplaceable, in that it cannot readily be performed by other political emotions, such as hope. Beyond providing a novel defence of anger, this argument has a broader upshot. Anger’s red mist reveals that ignorance is not always problematic in politics. Accordingly, it should not be treated—as has standardly been the case—as an unmitigated political evil. In the first instance, our efforts are better spent ascertaining when ignorance is a problem, and when, instead, it performs a felicitous function. (shrink)

Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study (...) has a qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient. (shrink)

Biobanks are important resources for improving public health and individual care. Some legal frameworks can be more or less conducive to advancing the potential benefits of biobanks. The purpose of this article is to assess biobanking legislation and practices in Spain to determine how well they fare in such a regard. We focus here on some of the primary ethical values that ground relevant legislation and that we believe are consistent with promoting biobanking benefits: the value of scientific research; efficient (...) use of scarce resources; and respect for the dignity of donors. We argue that although Spanish regulations advance these values in important ways, they also have provisions that undermine them and thus risk limiting the potential benefits of biobanks. We offer some suggestions for improvement. (shrink)

Background The COVID-19 pandemic has influenced the approach to the health-disease system, raising the question about the principles of bioethics present in physician–patient relations. The principles while widely accepted may not be sufficient for a comprehensive ethical analysis. Therefore, the aim of this study was to explore the perception of these principles and the physician–patient relationship during a hospital stay through a qualitative approach. Method Sixteen semi-structured interviews took place to know the patients’ perception during their 2020 hospitalization for COVID-19. (...) The data was analyzed through the constant comparison method, creating categories and comparing them. In the end, seven categories were established and were grouped in three: bioethical principles (dignity, charity, vulnerability, autonomy), doctor-patient relationship (participant commitment, informed consent, health staff-patient relationship) and the experience of the disease (illness, the role of the family). Results The research found that most patients described a positive experience, with the feeling of having been well cared for with no sense of discrimination or injustice done. The majority also reported that their autonomy was respected in the treatment decisions. The evaluation of these attitudes is an area of opportunity, especially when the patients' vulnerability is at risk. Conclusions The ethics of virtue offers a better reflection of how human beings manifest themselves by emphasizing the development of virtuous character and behaviors that allow them to realize their values in life. Authorized by the Research Ethics Committee with registration: DI/18/105-B/3/308. (shrink)