The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question,the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, empirical research has a (...) role to play in the description of morally relevant facts. It plays a role in answering the “reality-revealing questions” (what, why,how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses “the normative power of the factual,” which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research. (shrink)

: Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply--i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as the ultimate goal (...) of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor. (shrink)

Presumed consent alone will not solve the organ shortage, but it will create an ethical and legal context that supports organ donation, respects individuals who object to organ donation, relieves families from the burden of decision making, and can save lives.

Medical ethics enjoyed a remarkable degree of continuity from the days of Hippocrates until its long-standing traditions began to be supplanted, or at least supplemented, around the middle of the twentieth century. Scientific, technological, and social developments during that time produced rapid changes in the biological sciences and in health care. These developments challenged many prevalent conceptions of the moral obligations of health professionals and society in meeting the needs of the sick and injured .The Anglo-American textbook of Beauchamp and (...) Childress became the referential work for the discipline of `bio-ethics'. The authors are convinced that a long history of ancient, medieval and modern health care reflection remains very disappointing from the perspective of contemporary biomedical ethics: “It shows how inadequately, and with what measure of insularity, problems of truthfulness, privacy, justice, communal responsibility and the like were framed in past centuries ”. They defend the four principles approach to biomedical ethics, an approach which somewhat disparagingly has been called principlism.The influence of their work has been so strong that bio-ethics seemed to become overwhelmed by the importance of their contribution. It even created a large separation between Anglo-American approaches in bio-ethics and the European-Continental approach . In any case, contemporary biomedical ethics incorporates theoretical conflicts of considerable complexity, and the diverse theories make it no easier.The personalist approach to biomedical ethics presents itself as a typical European reaction to the rapid changes in medicine and health care. Some call it, however, a kind of renewal of the old Thomistic approach, whereby the concept of `nature' has been replaced by the more dynamic concept of `person'. In that way personalism has been situated by many observers as a `person' centred natural law tradition which focuses on the rational nature of the human person as the moral norm of nature. This gives the impression that personalism is only a very `static' variant of the natural law approach.I would, however, defend the opinion that personalism offers a very dynamic and creative approach to the complexities of recent developments in biomedicine. In what follows, I will illustrate this by clarifying two basic dimensions of the integration of personalism in biomedical ethics: the personalist approach offers a relational foundation for medicine as a healing profession and it presents an ethical framework for the integration of new developments in medicine. First, however, I would like to situate the importance of this theoretical reflection for medical ethics. (shrink)

The aim of this article is to take relational ethics concepts and apply them to the context of application to research ethics committees for approval to carry out research. The process of a multinational qualitative research application is described. The article suggests that a relational ethics approach can address two issues: how qualitative proposals are interpreted by research ethics committees and how this safeguards potentially vulnerable respondents. In relational terms, the governance of a research project may be enhanced by shared (...) ownership and willingness to engage in mutual dialogue. This challenges both researchers and research ethics committees to reframe their understanding of roles and functions in the assessment of research protocols, particularly those of a qualitative nature and those that address end-of-life issues. (shrink)

In this article, the place and the nature of an ethical dialogue that develops within Christian healthcare institutions in Flanders, Belgium is examined. More specifically, the question is asked how Christian healthcare institutions should position themselves ethically in a context of a pluralistic society. The profile developed by Caritas Catholica Flanders must take seriously not only the external pluralistic context of our society and the internal pluralistic worldviews by personnel/employees and patients, but also the inherent inspiration of a Christian healthcare (...) institution. This article concludes with ten general orientations that could shape the ethical dialogue from a Christian inspiration in a pluralistic context. (shrink)

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized in the (...) Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship. (shrink)

Objectives To describe the form and content of ethics policies on euthanasia in Flemish nursing homes and to determine the possible influence of religious affiliation on policy content. Methods Content analysis of euthanasia policy documents. Results Of the 737 nursing homes we contacted, 612 (83%) completed and returned the questionnaire. Of 92 (15%) nursing homes that reported to have a euthanasia policy, 85 (92%) provided a copy of their policy. Nursing homes applied the euthanasia law with additional palliative procedures and (...) interdisciplinary deliberations. More Catholic nursing homes compared to non-Catholic nursing homes did not permit euthanasia. Policies described several phases of the euthanasia care process as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and procedures for handling advance directives. Conclusion Our study revealed that euthanasia requests from patients are seriously considered in euthanasia policies of nursing homes, with great attention for palliative care and interdisciplinary cooperation. (shrink)

Belgium is the second country in the world that decriminalized euthanasia. On May 28, 2002 the Belgian Parliament approved the bill on euthanasia. With this approval, the political majority in the Belgian Parliament took a momentous decision concerning how we as a society deal with life and death.For many, euthanasia holds a promise. They take euthanasia literally as the ‘good death’. Others identify the recourse to euthanasia as a symptom of a ‘culture of death’. Given the importance of legislation on (...) euthanasia, an ethical reflection on the rationale and course of the Belgian debate on euthanasia urges itself.It is the aim of this contribution to shed light on the Belgian debate on euthanasia from an ethical perspective. The focus is thus rather on the arguments underlying the debate and their ethical assessment which implies the clarification of the values involved and the options made in the eventual legislation.To understand how and why the Belgian debate evolved as it did resulting in the final vote on the law on euthanasia, two reports of the Belgian Federal Advisory Committee on Bioethics are cardinal: the Advice n° 1 concerning the Desirability of Legislation on Euthanasia and the Advice n° 9 concerning the Termination of Life of Incompetent Patients .These two reports expressed the opinions and moral viewpoints present in Belgian society. After the presentation of the two reports and their underlying axiology we will examine what their relationship is with the eventual law on euthanasia which was the tailpiece of five years of public and political debate.In this examination, the pivotal question will be whether the legislature has succeeded in doing justice to the different moral viewpoints and the tendencies to a moral consensus that were formulated in the two reports. (shrink)

Certain events settle themselves in the collective memory of humankind where they keep functioning for decades as points of reference for future generations. The announcement of the successful cloning of Dolly was such an event. Every one of us will remember this thought-provoking occasion or will, at least, be confronted with the extended media coverage of this breakthrough in medical science. Immediately, world leaders reacted and the question was raised how long it would take before the shepherd was cloned. More (...) important is the sequel to this medical breakthrough: the successful Dolly experiment led to the possibility of human embryonic and adult stem cell research. In 2000, the Pontifical Academy for Life took a position on this additional and innovative research. At the same time, understanding these technological innovations takes a lot of time as a result of the immense scientific complexity of these new technologies. In this article, we want to clarify the technological possibilities as well as the moral, theological and ethical issues involved. To some, it seems that humans usurped the Divine Creator's place and, by doing this, crossed a border. To others, this medical breakthrough is in line with previous reproductive technological innovations. (shrink)

On September 23, 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world to have an act on euthanasia. Even though there is currently a legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia. Although euthanasia-related mortality rates in Belgium are low, ranging from 0.30% to 1.20%, it can be expected that caregivers will increasingly be confronted (...) with euthanasia requests and will, therefore, be more involved in the care for these patients. (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

The mechanical view on the human body may be considered as the context in which the highly technological medicine of these days originated. Organ transplantation is certainly one of the most impressive possibilities of this new evolution in medical technology. It exists by the grace of the paradigm of the body as a “Körper” : this paradigm leads to a self-evident acceptance of transplantation medicine in its most brilliant applications. Refinement of surgical techniques, better preservation of organs, the development of (...) more effective immunosuppressives, better procedures for the establishment of brain death criteria and better criteria for the selection and matching of donors and receptors are immanent goals of this type of medicine. Meanwhile the lives of many thousands of patients are saved and these patients even receive the chance for a new life, with much more quality. The ethical reflection on organ transplantation has followed rather rapidly this technical discourse and sounds as a kind of “moral engineering”. This is certainly connected with the upcoming success of “Principlism” , whereby medical decision making is oriented by applying four major principles to medical cases . It is also connected with the ethical approach of utilitarianism, which fits almost perfectly in this technological atmosphere. The authors question this approach and suggest that a more relational understanding of the human body as “Leib” would be a better paradigm for the promotion of solidarity in the context of organ donation and transplantation. Human beings do not only ‘have’ a body, but ‘are’ also their body. The body of the deceased refers to the life of a loved one. Technical procedures surrounding organ removals sometimes hinder the possibility for the family to bereave adequately around their loved one. The authors are convinced that the urging problem of organ shortage is not only caused by lack of solidarity or laziness, but also by the reductionist discourse of transplantation medicine itself. They suggest that we have to find – eventually with the help of poets and writers – an adequate new language to replace the alienating discourse of current transplantation medicine. They see also in communitarianism and personalist care ethics a better ethical approach for touching the peculiar sensitivities of eventual donors and receptors. (shrink)

The current debate on euthanasia in the Lowlands is a perfect examplification of the predominance of the principle of respect for autonomy in present-day medical-ethical decisionmaking. The aim of this article is the exploration of the more fundamental philosophical issues concerning the current status of autonomy in medical ethics. The starting point for this exploration is an analysis of the principle of respect for autonomy. The authors argue that the view on autonomy in contemporary bioethical discussions is more related to (...) the Millian understanding of autonomy rather than to Kant’s conception of respect for autonomy. The uncompromising veneration of personal autonomy and the subsequent view on the human self as unencumbered is placed under critique because this portrayal of the human person is rather unreal especially in medical-ethical decisionmaking where the fragility of human life is at stake. Furthermore, extending the claims of autonomy risks to undermine the public sphere. The defence of the principle of autonomy is taken on by the quality-of-life ethic that values human life because of its qualities. Being capable of making autonomous decisions is one of this main qualities. By this, the quality-of-life approach runs counter to an idea that is deeply ingrained in medicine, viz. the sanctity of human life that holds both the inviolability and the equal value of human life. These two approaches can, however, be integrated in Christian ethics by adopting a view on quality-of-life judgements in which the proportionality of benefits and burdens has a pivotal function. To conclude this article, the authors argue for a non-absolutist account of autonomy based on two modes of decentrement of the human self: the fundamental passivity at the core of the human person and the intersubjectivity of the human existence. (shrink)

In this article we first clarify the technological possibilities in an Age of Biological Control. Secondly we offer a short overview of some major international statements on reproductive cloning. Since a careful use of terminology will help public policy, we opt for a clarification of the means and purposes of human cloning in a third paragraph. Fourthly, we summarize the main arguments against human reproductive cloning from a bio-ethical point of view. The main objective is however the analysis of the (...) influence of two different theological interpretations of Imago Dei in the cloning debate: stewardship and created co-createdness. We evaluated the dynamic approach from a creational perspective to be the most apt for coping with new biotechnological developments. The authors conclude, however, that also this more dynamic theological approach leads to a radical rejection of reproductive cloning. (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

This commentary on Merks' contribution is essentially written from the impact the question of this symposium 'Where is truth?' can have in medical ethics. This well-organised discipline inside applied ethics reached the last decennia a highly functioning importance in the societal discussion on medical progress. The author of this commentary shares with Merks his critique on procedural ethics, a critique which is crucial for medical ethics. Indeed, ethical decision-making procedures have invaded the most important institutes of medical ethics. Recently, this (...) evolution has been criticised for neglecting to establish a foundational ethical culture for medicine. The author thinks personalist ethics can function as such a culture and as an answer to the need for a more comprehensive ethical approach. This leads him to his main critique on Merks' contribution: indeed, where Merks underlines the importance of 'human rights' concepts as a tool for ethical reflection, the author warns for the abuses of this concept in the Anglo-American approach of medical ethics, where the concept functions as an instrument for individual selfdetermination and doesn't refer to the - more Germanic - interpretation of this concept in the lines of a foundation of human dignity. Foundational moral concepts as fundamental disposition, human values and norms seem more apt to develop the type of ethics which is also supported by Merks. Even more it permits a really dynamic ethics, where the most humanly possible is realised in the light of the promotion of the most humanly desirable. (shrink)

Belgium and the Netherlands are the first countries in the world that have legalized euthanasia and assisted suicide. Since September 23, 2002, Belgian physicians can perform an act of euthanasia without at the same time performing a criminal act. In the Netherlands, the act on euthanasia went into force already on April 1, 2002. This special issue of Ethical Perspectives on ‘Euthanasia in the Low Countries’ offers a forum for critical dialogue on the different aspects of this new legal situation (...) in Belgium and the Netherlands.First, the legal situation will be introduced. In his contribution, Herman Nys makes a careful comparison of both laws. In spite of the fact that Belgium and the Netherlands are the first countries in the world that legalized euthanasia, the differences between the Belgian and Dutch law are fundamental. As Nys indicates, the scope of the Dutch law is more specified since it explicitly includes physician-assisted suicide while it remains unclear whether the Belgian act is also applicable in cases of assisted suicide. There are also fundamental differences regarding the persons regulated by the law, the health condition of the patient, the obligations of the physician with respect to the request and the health status of the patient, and the notification procedure.However, not only are there fundamental differences between Belgium and the Netherlands on the level of the law. Also the public debate and the values underlying the the debate show dissimilarities. In the Netherlands this debate took more than twenty years and the subsequent law on euthanasia reflected an existing medical practice. In Belgium, on the contrary, the parliament came to vote on the euthanasia law after only half a decade of debate. In our contribution , we identify the right to autonomy understood as ‘self-possession’ as the central value in the Belgian debate. Guy Widdershoven asserts that the moral basis of euthanasia in the Netherlands is different. He argues that the Dutch debate — and by now Dutch practice — cannot be reduced to the "principlist canon of autonomy and beneficence". Instead, the values of responsibility, deliberation and care are claimed to be central to Dutch euthanasia practice.In his contribution, Daniel Sulmasy offers an exhaustive analysis of the notion of dignity that constantly arises in the debate on euthanasia. For Christian churches and Catholic healthcare institutions, the recent legalization of euthanasia and assisted suicide is at least challenging. Jan Jans describes the way in which the main Christian churches in Belgium and the Netherlands engaged in the debate and reacted to the eventual legalization. Chris Gastmans presents the view of the Flemish Association of Catholic Healthcare Institutions.Law-making with respect to euthanasia is one thing. Bringing the law into practice is somewhat different. The question arises to what extent the new legal situation will bear upon the medical practice. Particularly, the responses of physicians are difficult to assess in advance. Physicians face the dilemma to report or not to report. They can take up their responsibility and report their practices of euthanasia, thereby exposing themselves to critical examination and possibly criminal prosecution. On the other hand, the physician can opt for safety and decide not to report his involvement in one of his patients’ euthanasia. In the latter case, the introduction of new legislation would have missed the mark. To this day, the only available data with regard to physicians’ reactions to an established legal framework wherein euthanasia is legalized come from the Netherlands. In his contribution, Albert Klijn presents the reactions of Dutch physicians to the new legal situation in their country and, particularly, the performance of their duty to report cases of euthanasia. Since the vote on the law in 2000 and the establishment of ‘regional review committees for termination of life on request and assisted suicide’ in 2001, the reports of euthanasia have declined. Klijn considers two possible explanations. On the one hand, there is insecurity about how the newly established regional review committees will evaluate physician' reports. On the other hand, the increased investment in research on palliative care and the availability of palliative sedation are held responsible for the drop in reported cases.This very interesting suggestion by Klijn needs further clarification. Therefore, the meaning of palliative care and the possibility of palliative sedation are elaborated in the contribution of Bert Broeckaert and Rien Janssens.With this special issue on ‘Euthanasia in the Low Countries’ we hope to have answered the numerous requests for further information on the Belgian and Dutch situation. Data, clarification and critical review may shed more light on the development of a practice, which some still consider as non-medical behaviour. This issue may therefore also function as a catalyst for further medical, ethical and legal debate. (shrink)

This commentary on Merks' contribution is essentially written from the impact the question of this symposium 'Where is truth?' can have in medical ethics. This well-organised discipline inside applied ethics reached the last decennia a highly functioning importance in the societal discussion on medical progress. The author of this commentary shares with Merks his critique on procedural ethics, a critique which is crucial for medical ethics. Indeed, ethical decision-making procedures have invaded the most important institutes of medical ethics. Recently, this (...) evolution has been criticised for neglecting to establish a foundational ethical culture for medicine. The author thinks personalist ethics can function as such a culture and as an answer to the need for a more comprehensive ethical approach. This leads him to his main critique on Merks' contribution: indeed, where Merks underlines the importance of 'human rights' concepts as a tool for ethical reflection, the author warns for the abuses of this concept in the Anglo-American approach of medical ethics, where the concept functions as an instrument for individual selfdetermination and doesn't refer to the - more Germanic - interpretation of this concept in the lines of a foundation of human dignity. Foundational moral concepts as fundamental disposition, human values and norms seem more apt to develop the type of ethics which is also supported by Merks. Even more it permits a really dynamic ethics, where the most humanly possible is realised in the light of the promotion of the most humanly desirable. (shrink)