BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative (...) care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

This short article provides an introduction to a special section, consisting of six papers on human evolution and the imago Dei. These papers are the result of dialogue between theologians and philosophers of religion at the University of Oxford and the Catholic University of Leuven. All contributors focus on the imago Dei, and consider how this theological notion can be understood from an evolutionary perspective, looking at a variety of disciplines, including the psychology of reasoning, cognitive science of religion, paleoanthropology, (...) evolutionary psychology, and evolutionary ethics. (shrink)

In this volume we present the proceedings from the fourth international Leuven Encounters in Systematic Theology (LEST IV, November 5-8, 2003), which focussed ...

Seattle, Prague, Quebec, Nice, Gothenburg, Genoa, Brussels, Barcelona, ≡ All these cities formed the setting of mass globalization protests. In most mass media reports, the presence of thousands of peaceful demonstrators has been outshone by the pictures of radical activists smashing McDonald's and Niketown. In the search for an adequate theological response to today's context of globalization, this article takes precisely this radical activism as a starting–point. In line with those postmodern iconoclasts’ own legitimation, a theological approach to this case (...) leads to the Marxist theory of fetishism and idolatry as it has already been investigated by liberation theologians two decades ago. Surprisingly, a renewed version of this critique of the theologization of economics can be found in No Logo , the trend–setting globalization critique written by the Canadian journalist Naomi Klein. A theological close reading of this best–selling book brings to the light a recurrent use of religious metaphor to characterize the corporate logo as a major aesthetic figure in the context of globalization. In order to understand the aesthetic and theological processes involved, a confrontation with the theological aesthetics of Hans Urs von Balthasar delivers a striking formal parallel between the Church's cross and today's corporate logo. Beyond an at first sight similar theo–aesthetic programme, Balthasar's theological aesthetics however opens up a position which enables us to expose the contemporary global socio–economic system as a subtly inverted Christianity. (shrink)

Through an exploration of the interpretation history of Matt. 25:33-46, this article develops an apocalyptic ethics based on Christ’s encountering us in the least of his brothers and sisters. Proposing the newly coined expression ‘ visitatio Christi’, the article offers a counterpoint to the common theological-ethical theme of imitatio Christi. First, it recalls how Jesus’ eschatological parable has time and again inspired love of the neighbour in need and challenged the scope of the required option for the poor. Next, the (...) article shows how an apocalyptic ethics based in Matthew 25, which imagines our moral life as a response to the visitatio Christi, implies a transformation of attitude/perception, a reversal of roles, and finds its source in the sacramental presence of Christ in the poor. Finally, the different aspects of the argument are recapitulated drawing upon Pope Francis’s use of Matthew 25. (shrink)

Love lies at the very heart of the Christian faith and its conception of both God and the human being. Nevertheless, the growing field of theological anthropology has yet to fully avail itself of philosophy’s and theology’s renewed attention to the theme of love. The Introduction to this special issue proposes the phrase ‘in the image of Love’ as an invitation to examine the relation between theological anthropology and love throughout the history of Christian thought. Guided by this motif, the (...) issue’s contributors consider ten historical thinkers on love and the human in relation to their philosophical conversation partners at the time. The volume thus has a genealogical dimension, delving into often forgotten layers beneath our current, late modern view of the human/love. It thereby assists future theological anthropological discussions in the much-needed task of both integrating the crucial theme of love and formulating more historically grounded perspectives. This special issue also reveals the ways in which theologians have attempted to respond to the challenge posed by the modern subject while retaining the idea that the human creature is called by Love and called to Love, and provides an alternative to Nygren’s opposition of agape and eros. (shrink)