This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by (...) responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity. (shrink)

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations warrant (...) research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

The best-interests standard is a widely used ethical, legal, and social basis for policy and decision-making involving children and other incompetent persons. It is under attack, however, as self-defeating, individualistic, unknowable, vague, dangerous, and open to abuse. The author defends this standard by identifying its employment, first, as a threshold for intervention and judgment (as in child abuse and neglect rulings), second, as an ideal to establish policies or prima facie duties, and, third, as a standard of reasonableness. Criticisms of (...) the best-interests standard are reconsidered after clarifying these different meanings. (shrink)

We have arrived at an inflection point, a moment in history when the sentience, conscious- ness, intelligence, agency, and even the moral agency of many nonhuman animals can no longer be questioned without ignoring centuries of accumulated scientific knowledge. Nowhere is this more true than in our understanding of nonhuman primates (NHPs). A neu- roethics committed to probing the ethical implications of brain research must be able to respond to and anticipate the challenges ahead as brain projects globally prepare to (...) increase the use of NHPs in research. This requires adopting a less anthropocentric focus that includes nonhuman animals within its scope. But the Neuroethics Roadmap represents a missed opportunity to critically examine the future direction of research with NHPs in an ethically-responsive neuroscience. (shrink)

The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state. The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that surrogates (...) should be permitted to make decisions to withdraw life-sustaining medical treatment from patients in the MCS. (shrink)

_The Routledge Handbook of Neuroethics_ offers the reader an informed view of how the brain sciences are being used to approach, understand, and reinvigorate traditional philosophical questions, as well as how those questions, with the grounding influence of neuroscience, are being revisited beyond clinical and research domains. It also examines how contemporary neuroscience research might ultimately impact our understanding of relationships, flourishing, and human nature. The _Handbook_ features easy-to-follow chapters that appear here for the first time in print and—written by (...) 61 key scholars and fresh voices—represent the wide range of viewpoints in neuroethics. The volume spotlights new technologies and historical articulations of key problems, issues, and concepts, and includes cross-referencing between chapters to highlight the complex interactions of concepts and ideas within neuroethics. These features enhance the _Handbook_’s utility by providing readers with a contextual map for different approaches to issues, and a guide to further avenues of interest. (shrink)

The Emerging Issues Task Force (Kellmeyer et al. 2019) identifies several important trends and concerns that neuroethics will encounter and grapple with in the com- ing decades. Among these are ethical issues related to the creation of new nonhuman entities, such as artificial intelligence systems, and human origin entities like brain organoids. The task force briefly mentions animal minds and animal rights, to which neuroethics to date has paid scant attention (Buller et al. 2014). As neuroscientific knowledge and knowledge from (...) other fields, including, to name a few, comparative psychology, primatology, ethology, biology, genetics, and medical sociology, accu- mulate, ethical concerns about the use of nonhuman ani- mals in research, agriculture, entertainment, and elsewhere will grow more visible and more urgent. Turning neuroethical attention toward nonhuman ani- mals also promises to illuminate issues related to specific human populations that are within the purview of a more expansive, forward-looking neuroethics. (shrink)

In this aricle, I argue that Descartes can be seen as a occupying a distinct middle ground between ancient music theory, which was being revived in the Renaissance, and eighteenth-century aestheticians. Descartes’ approach to music had its roots in humanist thought but, even from the start, it wasn’t simply another humanist theory of music. The views Descartes begins to develop in his early years, in the Compendium musicae (1618), is continuous with the views he articulates near the end of his (...) life in the Passions of the Soul (1649). And the position on the effects of music is an interesting and important one, bridging humanist thought with the new philosophy. Unlike the humanists, Descartes will be unwilling to identify particular musical proportions as intrinsically connected with pleasure or other affects, but he will nevertheless develop an objective account of aesthetic value. (shrink)

In the long section of anapaests with which they make their entry, the old men of Argos methodically deliver three essential messages to the audience: 40–71. It is the tenth year of the Trojan War. 72–82. We are men who were too old to go and fight in it. 83–103. Some new situation seems to be indicated by the fact that Clytemnestra is organizing sacrifices throughout the town.

There is ongoing ethical and legal debate about withdrawing life sup- port for patients with disorders of consciousness (DOCs). Frequently fu- eling the debate are implicit assumptions about the value of life in a state of impaired consciousness, and persistent uncertainty about the quality of life (QoL) of these persons. Yet there are no validated methods for assessing QoL in this population, and a significant obstacle to doing so is their inability to communicate. Recent neuroscientific discoveries might circumvent that problem (...) and help shed light on QoL in DOCs. There is an ethical imperative to prioritize QoL research in this patient population, to provide evidence to inform treatment, research, and end of life decisions. A minimalist and pragmatic model of QoL is proposed, targeting positive and negative affect as domains for which there is po- tential to reach across the communication gap, and restore to these voiceless persons some measure of control. (shrink)

Background: The search for genetic variants between racial/ethnic groups to explain differential disease susceptibility and drug response has provoked sharp criticisms, challenging the appropriateness of using race/ethnicity as a variable in genetics research, because such categories are social constructs and not biological classifications.Objectives: To gain insight into how a group of genetic scientists conceptualise and use racial/ethnic variables in their work and their strategies for managing the ethical issues and consequences of this practice.Methods: In-depth semi-structured interviews were conducted with a (...) purposive sample of 30 genetic researchers who use racial/ethnic variables in their research. Standard qualitative methods of content analysis were used.Results: Most of the genetic researchers viewed racial/ethnic variables as arbitrary and very poorly defined, and in turn as scientifically inadequate. However, most defended their use, describing them as useful proxy variables on a road to “imminent medical progress”. None had developed overt strategies for addressing these inadequacies, with many instead asserting that science will inevitably correct itself and saying that meanwhile researchers should “be careful” in the language chosen for reporting findings.Conclusions: While the legitimacy and consequences of using racial/ethnic variables in genetics research has been widely criticised, ethical oversight is left to genetic researchers themselves. Given the general vagueness and imprecision we found amongst these researchers regarding their use of these variables, they do not seem well equipped for such an undertaking. It would seem imperative that research ethicist move forward to develop specific policies and practices to assure the scientific integrity of genetic research on biological differences between population groups. (shrink)

How are we to understand the role of bioethics in the health care system, government, and academe? This collection of original essays raises these and other questions about the nature of bioethics as a discipline.

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

Purpose. Based on the study of philosophical anthropological concepts, to highlight the project of personality in different historical periods, to reveal the meaning of humanistic issues in the postmodern epoch, to identify the essential features of the image of human of the second half of the XX the beginning of the XXI century. Theoretical basis. The methodological basis of the article is the principles of historicism, integrity, objectivity regarding the mastery of the issue of person’s image in postmodernism. The research (...) applied comparative-historical, culturological, analytical, axiological approaches to reveal the problem of individuality in the second half of the XX the beginning of the XXI century. The theoretical basis of the article consists of scientific works in the field of philosophical anthropology, history, cultural studies, and aesthetics. Originality. The author revealed the peculiarities of transformation of the personality model from antiquity to postmodernism, specified the image of man of the second half of the XX the beginning of the XXI century. Conclusions. The analysis of anthropological ideas of Western philosophy of different ages shows the variety of views about understanding the nature of the person, its complexity and ambiguity. In the epoch of postmodernism humanistic issues are of particular relevance, which is connected with social and political uncertainty, domination of mass consciousness, loss of national and cultural identity. The image of a person of this period is deprived of a solid foundation, it is blurred and relative. The destruction of faith in the absolute in the context of the second half of the twentieth century contributed to the formation of confidence in the interdependence of all things, raised the problem of the personality image to a new ontological level. Orientation in the achievements of European civilization, perception of its anthropological experience, intercultural dialogue contribute to the productive use of the achievements of mankind in order to understand the modern person and to form its adequate image. In its essence, postmodernism does not set the goal to realize a retrospection of subject type. However, separating from the cultural memory the excerpts of ideas about a person, by certain styles and directions, it builds on their formations its own eclectic image of the individual. (shrink)

Recalcitrant disputes among health care providers and patients or their families may signal deep cultural differences about what interventions are needed or about clinicians’s professional duties. These issues arose in relation to a mother’s request for hymenoplasty or revirgination for her minor daughter to enable an overseas, forced marriage and protect her from an honor killing. The American College of Obstetrics and Gynecology committee recommends against members performing a hymenoplasty or other female genital cosmetic surgeries due to a lack of (...) data concerning their safety and efficacy. A key issue in such cases is how to determine what is in the minor’s best interest and the scope of health care moral or professional’s duties. The Best Interests Standard can serve as a powerful moral tool for resolving cross-cultural disputes and identifying needed policy. (shrink)

By the colours and decoration of a vase fragment one determines the period and style to which the original belonged; while its physical contours show from what part of the original it comes. The material may be insufficient for a reconstruction of the whole design. But it is often legitimate to go beyond what is actually contained in the preserved pieces.

Several of the treatises and lectures that make up the Hippocratic corpus begin with more or less extended statements about the physical composition and operation of the world at large, and approach the study of human physiology from this angle. We see this, for example, in De Natwra Hominis, De Flatibus, De Carnibus, De Victu; it was the approach of Alcmaeon of Croton, Diogenes of Apollonia, and according to Plato of Hippocrates himself. The work known as De Hebdomadibus would appear (...) to be a prime example of the type. The first twelve chapters are cosmological. They are dominated by two ideas: that everything in nature is arranged in groups of seven, and that the human body is constructed on the same pattern as the whole world. In the later part of the book we pass to the subject of fevers, their causation and treatment. But as Roscher observed, the cosmology and the pathology do not belong together. (shrink)

What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical (...) circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits. (shrink)

The status of the advanced potential solution in electromagnetic theory is analyzed and assessed. It is shown that the advanced potential solution does not violate a causality argument and that its existence in electromagnetic theory is on an exactly equal footing with the retarded potential solution. The general potential solution is thus completely symmetric. It is further shown that there is no “one-sidedness” in nature; oscillating electrons and orbiting electrons are just as good at absorbing energy as they are at (...) radiating it. These conclusions are sufficient to invalidate a number of theoretical models. (shrink)

In the twenty years since the first Earth Day, the environmental movement has become increasingly “commercialized.” In this paper, I examine why many environmental organizations now offer an array of products through catalogs and magazines, or manage stores and outlets. In part one, I explore some of the economic and political influences during the 1970s and 1980s that resulted in increased organizational sophistication and an increased production of environmental products. The part two, I explore the “commercialization” of environmentalism from two (...) angles. First, in terms of a deconstructionist critique of the system of commodities and image, I demonstrate that when environmental organizations partake in this consumer culture, they actually reproduce precisely the values and institutions that they criticize. Second, from a “constructionist” perspective, I argue that environmental products can re-enchant or reconnect people with nature, and thus can help change cultural attitudes about human-naturerelationships. I conclude that environmental products are contradictory because environmental merchandise is juxtaposed uneasily between environmental ideological rhetoric and material ambition. Environmental organizations must recognize this ambiguity before they can deal with the problem effectively. (shrink)