This article discusses the latest developments regarding euthanasia and palliative care in the Netherlands. On the one hand, a legally codified practice of euthanasia has been established. On the other hand, there has been a strong development of palliative care. The combination of these simultaneous processes seems to be rather unique. This contribution first focuses on these remarkable developments. Subsequently, the analysis concentrates on the question of how these new developments have influenced the ethical debate.
PurposeThe purpose of this paper is to develop a critique of value sensitive design (VSD) and to propose an alternative approach that does not depart from a heuristic of value(s), but from virtue ethics, called virtuous practice design (VPD).Design/methodology/approachThis paper develops a philosophical argument, draws from a philosophical method (i.e. virtue ethics) and applies this method to a particular case study that draws from a narrative interview.FindingsIn this paper, authors show how an approach that takes virtue instead of value as (...) the central notion for aiming at a design that is sensitive to ethical concerns can be fruitful both in theory and in practice.Originality/valueThis paper presents the first attempt to ground an approach aimed at ethical technology design on the tradition of virtue ethics. As such, it presents VPD as a potentially fruitful alternative to VSD. (shrink)
Nanotechnology is a swiftly developing field of technology that is believed to have the potential of great upsides and excessive downsides. In the ethical debate there has been a strong tendency to strongly focus on either the first or the latter. As a consequence ethical assessments of nanotechnology tend to radically diverge. Optimistic visionaries predict truly utopian states of affairs. Pessimistic thinkers present all manner of apocalyptic visions. Whereas the utopian views follow from one-sidedly focusing on the potential benefits of (...) nanotechnology, the apocalyptic perspectives result from giving exclusive attention to possible worst-case scenarios. These radically opposing evaluations hold the risk of conflicts and unwanted backlashes. Furthermore, many of these drastic views are based on simplified and outdated visions of a nanotechnology dominated by self-replicating assemblers and nanomachines. Hence, the present state of the ethical debate on nanotechnology calls for the development of more balanced and better-informed assessments. As a first step in this direction this contribution presents a new method of framing the ethical debate on nanotechnology. Thus, the focus of this paper is on methodology, not on normative analysis. (shrink)
With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)
BackgroundThere has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying. MethodsA cross-sectional study was conducted on a three-stage random sample of adult citizens of (...) the Republic of Croatia, stratified by regions, counties, and locations within those counties. In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis, correlation analysis and multiple regression analysis for data analysis.Results38.1% of the respondents agree with granting the wishes of dying people experiencing extreme and unbearable suffering, and withholding life-prolonging treatment, and 37.8% agree with respecting the wishes of such people, and withdrawing life-prolonging treatment. 77% of respondents think that withholding and withdrawing procedures should be regulated by law because of the fear of abuse. Opinions about the practice and regulation of euthanasia are divided. Those who are younger and middle-aged, with higher levels of education, living in big cities, and who have a more liberal worldview are more open to euthanasia. Assisted suicide is not considered to be an acceptable practice, with only 18.6% of respondents agreeing with it. However, 40.1% think that physician assisted suicide should be legalised. 51.6% would support the dying person’s autonomous decisions regarding end-of-life procedures.ConclusionsThe study found low levels of acceptance of withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. In addition, it found evidence that age, level of education, political orientation, and place of residence have an impact on people’s views on euthanasia. There is a need for further research into attitudes on different end-of-life practices in Croatia. (shrink)
The volume contributes to the ongoing nanoethics debate in four topical areas. The first part tackles questions of what could be called ‘meta-nanoethics’. Its focus lies on basic concepts and the issue of what - if anything - is truly novel and special about the new field of nanoethics or its subject matter. The second part of this volume presents a selection of interesting perspectives on some of the opportunities and challenges of nanotechnology. Part three takes a more in depth (...) look at one of the most pressing current concerns: how to deal with the risks and uncertainties surrounding nanotechnology in a responsible manner. In its fourth and final part the volume touches on issues of public debate and policy. (shrink)
This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three basic meta-ethical fallacies.
The field of medicine is generally greeted with great enthusiasm. This can be witnessed in the immense support for medical progress, which is widely hoped to lead to a realization of idealized goals. Indeed, with the help of medicine the human body would be controllable and constructible, human nature perfectible. However, enthusiasm in favor of medical progress is first and foremost a sentiment and, like all sentiments, not necessarily a product of rational contemplation. People are capable of enthusing about the (...) realization of utopian notions, such as life without disease or with the perfect body, without requiring any concrete arguments to back them up. Enthusiasm alone is not a guarantee of ethical desirability, however. Hence, this book takes a closer look at four research fields often referred to in medical utopian literature: 'tissue engineering', 'bioelectronics', 'germ line genome modification' and 'interventions in the biological aging process'. They serve as a basis for analyzing whether ethical arguments can be found to support the euphoric advocacy of the further development of these fields. (shrink)
This paper explores the relevance of the debate about ethical expertise for the practice of clinical ethics. We present definitions, explain three theories of ethical expertise, and identify arguments that have been brought up to either support the concept of ethical expertise or call it into question. Finally, we discuss four theses: the debate is relevant for the practice of clinical ethics in that it (1) improves and specifies clinical ethicists' perception of their expertise; (2) contributes to improving the perception (...) of moral competence of non-ethicists; (3) gives insight into complementary styles of argumentation of ethicists and non-ethicists; and (4) contributes to the awareness of the problem of profession-building of (clinical) ethicists. (shrink)
The objective of this article is to analyse and compare four methods of ethical case deliberation. These include Clinical Pragmatism, The Nijmegen Method of ethical case deliberation, Hermeneutic dialogue, and Socratic dialogue. The origin of each method will be briefly sketched. Furthermore, the methods as well as the related protocols will be presented. Each method will then be evaluated against the background of those situations in which it is being used. The article aims to show that there is not one (...) ideal method of ethical case deliberation, which fits to all possible kinds of moral problems. Rather, as each of the methods highlights a limited number of morally relevant aspects, each method has its strengths and weaknesses as well. These strengths and weaknesses should be evaluated in relation to different types of situations, for instance moral problems in treatment decisions, moral uneasiness and residue, and the like. The suggestion arrived at on the basis of the findings of this paper is a reasonable methodological plurality. This means that a method can be chosen depending on the type of moral problem to be deliberated upon. At the same time it means, that by means of a method, deliberation should be facilitated. (shrink)
In diesem Beitrag diskutieren drei interdisziplinär ausgebildete Akademiker, die als klinisch tätige Ethiker auch viele Jahre Erfahrungen mit Gesundheitssystemen in verschiedenen Ländern haben, die Frage nach dem Kern klinisch-ethischer Expertise: der niederländische Mediziner und Philosoph Henk ten Have, Direktor des Center for Healthcare Ethics in Pittsburgh, USA, der deutsche Theologe und Philosoph Norbert Steinkamp, Professor für theologisch-ethische Grundlagen sozialprofessionellen Handelns an der katholischen Hochschule für Sozialwesen in Berlin, der 12 Jahre die klinische Ethik der Universitätsklinik Nijmegen, Niederlande, geleitet hat, sowie (...) der niederländische Philosoph und Historiker BertGordijn, Direktor des Institute of Ethics der Dublin City University, Irland, Präsident der International Association of Education in Ethics und u. a. Herausgeber von Medicine, Health Care and Philosophy. (shrink)
This paper focuses on the practice of injecting patients who are dying with a relatively high dose of sedatives in response to a catastrophic event that will shortly precipitate death, something that we term ‘crisis sedation.’ We first present a confabulated case that illustrates the kind of events we have in mind, before offering a more detailed account of the practice. We then comment on some of the ethical issues that crisis sedation might raise. We identify the primary value of (...) crisis sedation as allowing healthcare professionals to provide some degree of reassurance to patients, their families and the professionals who are caring for them. Next we focus on the issue of informed consent. Finally, we ask whether continuous deep sedation might be preferable to crisis sedation in scenarios where potential catastrophic events can be anticipated. (shrink)
This contribution focuses on two claims advanced by the proponents of the project of “Converging Technologies for Improving Human Performance.” Firstly, it is maintained that this project represents something genuinely new and quite unique. Secondly, it is argued that the future prospects of the project are extraordinarily positive. In order to critically assess both claims this paper first focuses on the question of whether there is actually anything genuinely new about the project of improving human performance by means of converging (...) NBIC technologies. In addition it is analyzed whether the project warrants that we be optimistic about its future prospects. (shrink)
Geoengineering as a technological intervention to avert the dangerous climate change has been on the table at least since 2006. The global outreach of the technology exercised in a non-encapsulated system, the concerns with unprecedented levels and scales of impact and the overarching interdisciplinarity of the project make the geoengineering debate ethically quite relevant and complex. This paper explores the ethical desirability of geoengineering from an overall review of the existing literature on the ethics of geoengineering. It identifies the relevant (...) literature on the ethics of geoengineering by employing a standard methodology. Based on various framing of the major ethical arguments and their subsets, the results section presents the opportunities and challenges at stake in geoengineering from an ethical point of view. The discussion section takes a keen interest in identifying the evolving dynamics of the debate, the grey areas of the debate, with underdeveloped arguments being brought to the foreground and in highlighting the arguments that are likely to emerge in the future as key contenders. It observes the semantic diversity and ethical ambiguity, the academic lop-sidedness of the debate, missing contextual setting, need for interdisciplinary approaches, public engagement, and region-specific assessment of ethical issues. Recommendations are made to provide a useful platform for the second generation of geoengineering ethicists to help advance the debate to more decisive domains with the required clarity and caution. (shrink)
Introducing a special issue of a journal is a difficult, but pleasurable task for any editor. One must chose what to say about the themes of the issue, and how to introduce the papers presented. However, this task becomes still more complex when the special issue in question forms the inaugural issue of a new journal. This is the case here as we find ourselves introducing "Questions in Human Enhancement" as the inaugural issue of Studies in Ethics, Law and Technology. (...) As such, this editorial serves two purposes: first we must introduce the journal itself, exploring our motivations for creating a new, quasi-open access, interdisciplinary publishing forum; and second we must introduce a stunning collection of comments, articles and discussion papers that have been written by a range of eminent scholars from across the globe. (shrink)
When we founded Studies in Ethics, Law and Technology we wondered if we might, like Icarus, be trying to fly too close to the sun. Had we set ourselves an impossible task in seeking to create a new community of interdisciplinary scholars under the umbrella of the words ethics, law and technology? Would expert scholars in biotechnologies, nanotechnologies, neurotechnologies, information technologies, weapons and security technologies, energy and fuel technologies, space based technologies, and/or new media and communication technologies all come together (...) in one place? As we show in this editorial, the answer is yes. (shrink)
This editorial explores the concept of ethics, law and technology within the context of policymaking. It draws upon the concepts of argument, concern and risk, alongside a presentation of the importance of utilizing a broad range of methods and perspectives in research in order to ensure good quality governance.
In this article, the question is discussed if and how Healthcare Ethics Committees (HECs) should be regulated. The paper consists of two parts. First, authors from eight EC member countries describe the status quo in their respective countries, and give reasons as to the form of regulation they consider most adequate. In the second part, the country reports are analysed. It is suggested that regulation of HECs should be central and weak. Central regulation is argued to be apt to improve (...) HECs’ accountability, relevance and comparability. To facilitate biomedical citizenship and ethical reflection, regulation should at the same time be weak rather than strict. Independence of HECs to deliberate about ethical questions, and to give solicited and unsolicited advice, should be supported and only interfered with by way of exception. One exception is when circumstances become temporary adversarial to ethical deliberation in healthcare institutions. In view of European unification, steps should be taken to develop consistent policies for both Eastern and Western European countries. (shrink)
In pluralistic modern societies, moral dissent will, to an increasing extent, be an inescapable fact in our lives. Moral dissent, however, involves various serious dangers: escalation of conflicts, the use of violence, flourishing of radical extremism and even civil war. There are basically two ways in which these threats can be addressed: coercive enforcement of consensus or tolerance. First, we could try to eliminate moral dissent by using more dictatorial forms of consensus formation, like propaganda, indoctrination and terror. This, however, (...) would endanger or even destroy the open society. Therefore, from a moral point of view, tolerance appears to be the more desirable antidote to the unwanted effects of moral dissent. This paper aims to contribute to the discussions about the regulation of moral dissent and the formation of moral consensus by analyzing one of the most important and idiosyncratic elements of the Dutch way of handling these issues: pragmatic tolerance. First, some general thoughts are developed about moral consensus, moral dissent and tolerance as a means of regulating dissent. In addition, the characteristic Dutch policy of pragmatic tolerance is described. Finally, some of the pros and cons of pragmatic tolerance are analyzed from an ethical perspective. (shrink)
Zusammenfassung. Die niederländische Euthanasie-Politik erzeugt immer wieder Verwunderung in anderen Ländern: Grundsätzlich stellt Euthanasie sowohl in den Niederlanden als auch im Ausland einen strafbaren Tatbestand dar. Und hier wie dort werden unter bestimmten Umständen derartige Fälle geduldet. Im Ausland geschieht diese Duldung, falls überhaupt geduldet wird, im allgemeinen stillschweigend und inoffiziell. Die niederländischen Behörden dagegen regeln aktiv und öffentlich diejenigen Fälle von Euthanasie, in denen keine Strafverfolgung eingeleitet wird. Man gibt im voraus an, unter welchen Umständen der betreffende Arzt keine (...) Strafverfolgung zu befürchten hat. Mit der vorliegenden Abhandlung wird mittels eines kurzen Rückblicks in die Geschichte der früheren Republik der Niederlande eine historische Erklärung des typisch niederländischen Phänomens des gedogen gegeben. Im Anschluß wird aufgezeigt, inwieweit gedogen im Bereich der niederländischen Euthanasie-Politik zum Tragen kommt. (shrink)
The aim of this paper is to analyse the ethical issues relating to privacy that arise in smart homes designed for people with dementia and for people with intellectual disabilities. We outline five different conceptual perspectives on privacy and detail the ways in which smart home technologies may violate residents’ privacy. We specify these privacy threats in a number of areas and under a variety of conceptions of privacy. Furthermore, we illustrate that informed consent may not provide a solution to (...) this problem. We offer a number of recommendations that designers of smart homes for people with dementia and people with intellectual disabilities might follow to ensure the privacy of potential residents. (shrink)
Diese philosophische Arbeit behandelt das Problem der Bestimmung von Grenzen der Person. Sie kritisiert zwei Aspekte der seit J. Locke bestehenden Debatte uber das Problem der Personenidentitat: zum einen die Unzulanglichkeit der Formulierung des Problems, zum anderen das Fehlen einer soliden Theorie uber die Person als Grundlage der Debatte. Zur Behebung der entdeckten Unzulanglichkeit wird eine adaquate Formulierung des Problems entwickelt. Sie erfasst das Problem mit Hilfe des Begriffs der Grenze der Person. Dem zweiten Kritikpunkt wird dadurch begegnet, dass eine (...) fundierte Theorie uber die Person aufgestellt wird. Die Analyse des Problems auf der Grundlage der entwickelten Theorie zeigt schliesslich die Unmoglichkeit einer wohlbegrundeten Bestimmung von Grenzen der Person auf.". (shrink)
If one compares the development of modern medical ethics in Germany with those in the Netherlands, what stands out are the cultural and intellectual differences between the two countries. Dealing with the problems involved in limiting medical treatment, the authors show the differing and the common standards and values on which the discussion of this is based in both countries. Three examples, active termination of life, the do-not-resuscitate order and pain management, which are examined from an historical, legal, philosophical and (...) ethical perspective, put this in concrete terms. The authors belong to different generations as well as different political and philosophical camps. Vergleicht man die Entwicklung der modernen Medizinethik in Deutschland mit jener in den Niederlanden, fallen die kulturellen und intellektuellen Unterschiede zwischen beiden Landern deutlich auf. Anhand der Problematik der Begrenzung medizinischen Handelns zeigen die Autoren die verschiedenen bzw. gemeinsamen Normen und Werte, die der Diskussion daruber in beiden Landern zugrunde liegen. Drei Beispiele, die aktive Lebensbeendigung, die Nicht-Reanimierung und die Schmerzbekampfung, die aus historischem, juristischem, philosophischem und ethischem Blickwinkel betrachtet werden, konkretisieren die Darstellung. Die Autoren gehoren unterschiedlichen Generationen, politischen und lebensanschaulichen Lagern an. (shrink)
Definition of the Problem: The ethical debate on the cloning of human beings is by no means new. Its history goes back to the middle of the 1960s. However, the theoretical level of the contents of this debate still doesn't seem to have got past its initial stages.Arguments and conclusion: First, a short overview will be given of these 30 years of history of ethical debate, and some central concepts will be explained. Subsequently a critical analysis will be made of (...) the arguments for and against the cloning of people which are used in this debate. The intention of this exposition is to stimulate further ethical discussion on the cloning of human beings. (shrink)