Bioethics
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The concept of person is integral to bioethical discourse because persons are the proper subject of the moral domain. Nevertheless, the concept of person has played no role in the prevailing formulation of human death because of a purported lack of consensus concerning the essential attributes of a person. Beginning with John Locke's fundamental proposition that person is a 'forensic term', I argue that in Western society we do have a consensus on at least one necessary condition for personhood, and that is the capacity for conscious experience. ⋯ Such a formulation would, in theory, apply to any member of the animal kingdom. I suggest that an appropriate concept of death should capture what it is about a particular living being that is so essential to it that the permanent loss of that thing constitutes death. What is essential to being a human being is living the life of a person, which derives from the capacity for conscious experience.
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In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. ⋯ Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self-determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death.
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It is becoming increasingly common (at least in the United States) for doctors to appeal to futility judgments as the basis for certain types of clinical decisions, such as the decision to withhold CPR. The clinical use of futility judgments raises two basic questions regarding futility. ⋯ I argue that futility determinations need to be distinguished from two other types of value-based judgments, namely, identification of the goals of treatment and treatment decisions based on an assessment of the benefits and burdens of treatment. If this distinction is sound, it suggests a very limited role for futility determinations in clinical decision-making, a role which should serve to promote communication between doctor and patient.
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Perhaps no American state has seen more legal activity on assisting suicide than Michigan, but despite legislation, a study Commission, several legal cases and a state Supreme Court ruling, the state seems much further from a humane resolution of the question than when the activities of Dr. Jack Kevorkian began in June of 1990. This note summarizes major legal events over a twelve-month period (ending May '95), which included jury acquittal of Dr. ⋯ Kevorkian declaring assisting suicide a common law felony and ruling that in certain circumstances a person assisting suicide can be prosecuted for murder. The Commission's model decriminalization proposal and the bills subsequently introduced in the legislature (all of which to varying degrees surrounded assisting suicide with restrictions and safeguards), as well as the decision of the Supreme Court, are discussed. Certain puzzling features of the latter, especially with regard to the kind of causation that can turn helping another commit suicide into murder are noted.
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The discussions of these past twenty years have significantly improved our knowledge about the foundation of bioethics and the meaning of the four bioethical principles with concern to at least three different points: that they are organised hierarchically, and therefore not "prima facie" of the same level; that they have exceptions, and consequently lack of absolute character; and that they are neither strictly deontological nor purely teleological. The only absolute principle of moral life can be the abstract and unconcrete respect of human beings. But when determining the material content of this respect, principles become contingent and relative. ⋯ The first material moment is comprised of the four bioethical principles, divided into two levels, one private, including the principles of autonomy and beneficence, and the other one public, including those of nonmaleficence and justice. The second material moment deals with specific cases, and requires analysis of their context, including their circumstances and consequences. Only when following these steps, and therefore balancing principlism and contextualism, can moral reasoning be correct and complete.