Self‐Euthanasia,the Dutch Experience: In Search for the Meaning of a Good Death or Eu Thanatos

My main purpose in this article is to establish the meaning of a ‘good death’ when death is self‐chosen. I will take as my point of departure the new notion of ‘self‐euthanasia’ and the corresponding practice that has evolved in the Netherlands in recent years. Both physician‐euthanasia and self‐euthanasia refer to an ideal process of a good death, the first being ultimately the physician's responsibility, while the second is definitely the responsibility of the individual choosing to die. However, if we also accept the existence of a fundamental moral difference between ending another person's life and ending your own life, and if we accept this moral difference to be also relevant to the normatively laden good death, then this difference represents a strong reason for preferring self‐euthanasia to physician‐euthanasia.     

Understanding Community Norms Surrounding Tobacco Sales

Background

In the US, denormalizing tobacco use is key to tobacco control; less attention has been paid to denormalizing tobacco sales. However, some localities have placed limits on the number and type of retailers who may sell tobacco, and some retailers have abandoned tobacco sales voluntarily. Understanding community norms surrounding tobacco sales may help accelerate tobacco denormalization.

Methods

We conducted 15 focus groups with customers of California, New York, and Ohio retailers who had voluntarily discontinued tobacco sales to examine normative assumptions about where cigarettes should or should not be sold, voluntary decisions to discontinue tobacco sales, and government limits on such sales.

Results

Groups in all three states generally agreed that grocery stores that sold healthy products should not sell tobacco; California groups saw pharmacies similarly, while this was a minority opinion in the other two states. Convenience stores were regarded as a natural place to sell tobacco. In each state, it was regarded as normal and commendable for some stores to want to stop selling tobacco, although few participants could imagine convenience stores doing so. Views on government''s role in setting limits on tobacco sales varied, with California and New York participants generally expressing support for restrictions, and Ohio participants expressing opposition. However, even those who expressed opposition did not approve of tobacco sales in all possible venues. Banning tobacco sales entirely was not yet normative.

Conclusion

Limiting the ubiquitous availability of tobacco sales is key to ending the tobacco epidemic. Some limits on tobacco sales appear to be normative from the perspective of community members; it may be possible to shift norms further by problematizing the ubiquitous presence of cigarettes and drawing connections to other products already subject to restrictions.     

Spongiform encephalopathy,cannibalism and Neanderthals extinction

There are paleoecological evidences that Neanderthals ate the brains of deers and goats as well that of their own deceased. This would expose each individual and the population to the risks of contracting the Creutzfeldt Jacob disease. Those who consumed the remains of infected individual’s would then contract the disease and eventually infect others. If this is the case then the Neanderthal extinction could be attributed to spongiform encephalopathy and not to the cultural supremacy of the anatomically modern man.     

African communal basis for autonomy and life choices

I argue that the metaphysical capacity of autonomy is not intrinsically valuable; it is valuable only when used in relation to a community's values and instrumentally for making the proper choices that will promote one's own and the community's well‐being. I use the example of the choice to take one's life by suicide to illuminate this view. I articulate a plausible African conception of personhood as a basis for the idea of relational autonomy. I argue that this conception is better understood as a social‐moral thesis, and not a metaphysical thesis. A metaphysical thesis gives an account of the abstract nature of an atomic individual, his agency, and rational choice. The social‐moral thesis indicates that personhood and autonomy are positive and relational to the life plans, well‐being, material conditions, and the best means for achieving them that are made available and possible by harmonious living in a community. This idea of autonomy is not just having the capacity of freewill; it also involves how such freewill is used, in terms of how an individual's choices are guided by internalized communal values.     

Beneficial Coercion in Psychiatric Care: Insights from African Ethico‐Cultural System

There is a ‘catch 22’ situation about applying coercion in psychiatric care. Autonomous choices undeniably are rights of patients. However, emphasizing rights for a mentally‐ill patient could jeopardize the chances of the patient receiving care or endanger the public. Conversely, the beneficial effects of coercion are difficult to predict. Thus, applying coercion in psychiatric care requires delicate balancing of individual‐rights, individual well‐being and public safety, which has not been achieved by current frameworks. Two current frameworks may be distinguished: the civil liberty approach and the Stone model. Both frameworks are restrictive, and not respectful of human dignity. In a civil liberty approach, individuals who are severely mentally‐ill but not dangerous would be denied care because they do not meet the dangerousness threshold or because the use of coercion will not lead to rebirthing of autonomy. This is unsatisfactory. Albeit involuntary interventions such as talk therapies, peer‐support etc., may not always lead to rebirthing of autonomy or free patients from mental illness; they can however help to maintain the dignity of each mentally ill patient. In place of these frameworks, this study proposes a new ethical framework for applying coercion in psychiatric care that is respectful of human dignity. Specifically, it draws on insights from the African ethico‐cultural system by using the Yoruba concept Omo‐olu‐iwabi to develop this new framework. This way, the study shows that only a more respectful approach for applying coercion in psychiatric care can lead to the careful balancing of the competing interests of individual's rights, individual's well‐being and public safety.     

American Kitchens,Luxury Bathrooms,and the Search for a 'Normal' Life in Postsocialist Hungary

Throughout the post-Soviet bloc, people regularly describe as 'normal' high-quality commodities and living environment so therwise considered extraordinary in their local context. In Hungary, this discourse of the normal indicates that middle-class aspirants, claiming 'European' status, now evaluate their own standards of living by comparison to imagined western ones. Looking to the socialist period, I argue that the construction of a socialist modern consumer led to the equation of western standards of living with self-value and dignity. Western material worlds were perceived to be conducive to a form of family life and personhood impossible under the 'abnormal' conditions of state-socialism. As this new standard comes to dictate middle-class fashioning, it becomes instrumental in the ongoing social, economic and material transformation of the country.     

Perspectives on human stem cell research

Human stem cell research draws not only scientists' but the public's attention. Human stem cell research is considered to be able to identify the mechanism of human development and change the paradigm of medical practices. However, there are heated ethical and legal debates about human stem cell research. The core issue is that of human dignity and human life. Some prefer human adult stem cell research or iPS cell research, others hES cell research. We do not need to exclude any type of stem cell research because each has its own merits and issues, and they can facilitate the scientific revolution when working together. J. Cell. Physiol. 220: 535–537, 2009. © 2009 Wiley‐Liss, Inc.     

Hastening death and respect for dignity: Kantianism at the end of life

Suppose that a young athlete has just become quadriplegic. He expects to live several more decades, but out of self‐interest he autonomously chooses to engage in physician‐assisted suicide (PAS) or voluntary active euthanasia (VAE). Some of us are unsure whether he or his physician would be acting rightly in ending his life. One basis for such doubt is the notion that persons have dignity in a Kantian sense. This paper probes responses that David Velleman and Frances Kamm have suggested to the question of whether participating in PAS or VAE to benefit oneself, as the young man might, respects the dignity of persons, specified in an orthodox Kantian way. Velleman claims that it does not, while Kamm insists that, in certain circumstances, it does. I argue against Kamm's position. I go on to contend that while orthodox Kantianism might provide a basis for moral concern regarding the case of the young quadriplegic, it suffers from two serious shortcomings. First, it implies that terminally ill patients are wrong to request VAE or engage in PAS to avoid intense suffering, at least when this suffering has not yet overwhelmed their reason. Second, orthodox Kantianism implies that it is wrong for physicians to withdraw such patients from life‐sustaining treatments, even if they request it. To remedy these shortcomings, I sketch an unorthodox Kantian account of respect for the dignity of persons. This account promises to capture the idea that it would be morally problematic for doctors to help the young quadriplegic to die, but to avoid the shortcomings of an orthodox Kantian account.     

COERCION,AUTONOMY, AND THE PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION

The debate concerning whether to legalize and regulate the global market in human organs is hindered by a lack of adequate bioethical language. The author argues that the preferential option for the poor, a theological category, can provide the grounding for an inductive moral epistemology adequate for reforming the use of culturally Western bioethical language. He proposes that the traditional, Western concept of bioethical coercion ought to be modified and expanded because the conditions of the market system, as viewed from the perspective of organ vendors systemically deprived of access to sufficient resources, are sufficiently exploitative as to diminish the possibility of these vendors giving informed consent. Moreover, empirical studies conducted by professionals in medicine, sociology, psychiatry, economics, and medical anthropology continue to contribute support to the growing interdisciplinary consensus that functionally coercive structural factors exert the most significant influence upon a vendor's decision to sell an organ within any market, regardless of legality or degree of regulation. Therefore any proposal to legalize and regulate the organ market remains patently unethical because doing so would likely function to constrain further the agency of poor potential vendors.     

The trade in human liver lobes: bioviolence against organ sellers in Bangladesh

The rapid growth in organ transplantation has created an illicit trade in human organs. The kidney trade has flourished in the last few decades, but in the last few years this has been coupled with an emerging liver trade. This article examines the liver trade sourced from poor sellers in Bangladesh. Through ethnographic fieldwork, I investigate how a landless farmer and a village housewife both sell their liver lobes on the black market, and how the recipients undergo liver transplants in Bangladesh and India. I reveal that liver selling, like kidney selling, is primarily driven by the sellers’ debt. What is surprising, though, in this anthropological analysis is that microcredit, a Nobel Prize-winning economic operation, has negatively contributed to organ selling in Bangladesh. I discover that the liver trade leads to tragic outcomes for both sellers and recipients: the sellers could not repay their loans by selling a liver lobe, while one of the recipients died just over a month after the surgery. I therefore argue that liver trade is advancing through a series of disturbing ironies, resulting in bioviolence, exploitation, and suffering for the vulnerable victims.     

Justice and global care chains: Lessons from Singapore

Growing demand for direct care workers to assist care‐dependent elderly people has created an opening for migrant workers from low‐ income nations to sell their services to middle and high‐income nations. Using Singapore as a case example, we draw on capability theory to make the case that receiving nations that import direct care workers should be held to global justice standards that protect workers’ floor level human capabilities. Specifically, we (1) show that Singapore and other receiving nations fail to protect human capabilities at a threshold level required by dignity; (2) identify specific human capabilities placed at risk; and (3) recommend standards for receiving nations that support central capabilities. As populations in both developed and developing nations are rapidly aging, these concerns could not be timelier.     

The Indignity of Relative Concepts of Animal Dignity: A Qualitative Study of People Working with Nonhuman Animals

The Swiss animal welfare legislation is considered to be one of the strictest such laws worldwide. One unique feature is the inclusion of the concept of “dignity of the creature” and, more precisely, animal dignity. We interviewed 19 people from Switzerland and Germany about their concepts of animal dignity. Thereby, we investigated whether the very specific concept of the Swiss law is reflected in the minds of those who work with nonhuman animals on a daily basis. The results of our qualitative interviews revealed an awareness of the legal term among Swiss interviewees, but their personal concepts of animal dignity were not based on or similar to the legal definitions. The interviewed participants presented a broad range of concepts, including: similarities to human dignity, replacing concepts such as respect or integrity, and context-dependent, contingent forms of dignity. The applicability or usefulness of animal dignity was questioned by several participants; many judged it to be confusing or difficult. Therefore, we conclude by discussing animal integrity as an alternative concept that reflects the interviewees’ ideas of treating nonhuman animals in a respectful and appropriate way, and at the same time does not have the strongly metaphysical connotations of a concept such as human dignity.     

Should Deceased Donation be Morally Preferred in Uterine Transplantation Trials?

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant (UTx) as a treatment for absolute uterine factor infertility (AUFI). Should it reach clinical application this procedure would allow such individuals what is often a much‐desired opportunity to become not only social mothers (via adoption or traditional surrogacy arrangements), or genetic and social mothers (through gestational surrogacy) but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as a therapeutic option falls firmly into the camp of the quality of life (QOL) transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors. In this article, in the light of the recent nine‐case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living.     

Women Use Red in Order to Attract Mates

Among certain non‐human primates, the red‐colored genitalia of females are a sexual ornament and attract males. The preference for red clothes among women is at times explained as being a parallel. We used here a within‐individual design to investigate the signaling role of the color red with a sample of Slovak participants. As expected, women preferred red clothing both in real‐life and would‐be situations more than men. The preference for red (but not for other colors) in mating game scenarios was only significant for women, but not for men. A preference for the color red was shown in particular for clothes on the upper parts of the participants' bodies, irrespective of gender. Women who were actually involved in a romantic sexual relationship had a preference for red in would‐be situations more than single women, although the menstrual cycle, the total number of lifetime sexual partners, and self‐perceived attractiveness were not associated with the preference for the color red. Our results support the sexual signaling hypothesis which suggests that women use the color red to attract potential mates in a similar way as non‐human primates.     

ON THE MORALITY OF GUINEA‐PIG RECRUITMENT

Can it be wrong to conduct medical research on human subjects even with their informed consent and even when the transaction between the subjects and researchers is expected to be mutually beneficial? This question is especially pressing today in light of the rise of a semi‐professional class of ‘guinea pigs’– human research subjects that sell researchers a right of access to their bodies in exchange for money. Can these exchanges be morally problematic even when they are consensual and mutually beneficial? I argue that there are two general kinds of concern one can have about such transactions – concerns about the nature of what is sold and concerns about the conditions in which the selling occurs. The former involves worries about degradation and the possible wrongness of selling a right of access to one's body. These worries, I argue, are not very serious. The latter involves worries about coercion, exploitation, and undue influence – about how, by virtue of their ignorance, impulsiveness, or desperation, guinea pigs can be taken advantage of by medical researchers. These worries are quite serious but I argue that, at least in cases where the exchange between guinea pigs and researchers is consensual and mutually beneficial, they do not raise insurmountable moral problems.     

To relieve or to terminate? A Confucian ethical reflection on the use of morphine for late‐stage cancer patients in China

Morphine is usually preferred to treat moderate or severe pain for late‐stage cancer patients. However, medically unindicated or excessive morphine use may result in respiratory depression and death. This essay contends that a clear distinction between relieving pain and performing active euthanasia in the use of morphine should be made in practice. By drawing on Confucian virtue resources, we construct a Confucian conception of human dignity, including both intrinsic and acquired dignity, to analyze the circumstances of morphine use in current China. We argue that not only the Confucian view of intrinsic dignity but also that of acquired dignity would not support morphine euthanasia.     

The anxiety of romantic love in Ho Chi Minh City,Vietnam

This article examines the role of anxieties about romantic love in the modernist self‐making projects of Vietnam's growing middle class. Romantic ideals and discourses that emerged from Vietnam's neoliberal reforms emphasize personal compatibility through emotional intimacy and communication. Middle‐class residents of Ho Chi Minh City increasingly privilege the emotions in daily life and define themselves and their relationships in an affective register. This cultivation of emotional self‐reflexivity has, however, become a source of anxiety about the self. An analysis of two case studies traces how individuals draw on their class, gender, and age to negotiate conflicts between various models of love and selfhood and reinvent romantic discourses to claim their own versions of a modern identity. A critical component of both the experience of romantic love and the construction of middle‐class Vietnamese selfhood, love anxiety stems not just from people's changed relations to others but also from a changed perception of the self, which has been rendered unrecognizable to them.     

Schuld und Verantwortung

Guilt and responsibility In criminal law, the notion of guilt is based on the metaphysical principle of free will implying the ability to “do otherwise” under identical physico‐psychical conditions. This stands in contradition to scientific thinking as well as psychological and neurobiological insight into the development of personality and motive structures. It is proposed to replace the notion of free will by that of formation of will in private law. This implies the ability to adequately deliberate the conditions and possible consequences of one's own actions. This ability is understood as the result of normal development of the brain and its cognitive, emotional and executive functions. From this derives the responsibility of a person for his or her actions.     

A patient's guide to choosing unconventional therapies

Unconventional therapies (UTs) are therapies not usually provided by Canadian physicians or other conventionally trained health care providers. Examples of common UTs available in Canada are herbal preparations, reflexology, acupuncture and traditional Chinese medicine. UTs may be used along with conventional therapies (complementary) or instead of conventional therapies (alternative). Surveys have shown that many Canadians use UTs, usually as complementary therapies, for a wide range of diseases and conditions. Reliable information about UTs is often difficult to find. Your doctor may be unable to give you specific advice or recommendations, since UTs are often not in a physician''s area of expertise. However, he or she will usually be able to provide some general advice and help supervise your progress. For your own health and safety, it is important to keep your doctor informed of the choices you make. This document is intended to (a) provide you with questions to consider when making your treatment choices, (b) help you find information about UTs, (c) help you decide whether a specific UT is right for you, and (d) provide tips to help you evaluate the information you find.     

HEALTH,VITAL GOALS,AND CENTRAL HUMAN CAPABILITIES

I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free‐standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society‐relative vital goals with a human species‐wide conception of basic vital goals, or ‘central human capabilities and functionings’. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings—or having the overarching capability, a meta‐capability, to achieve a set of central or vital inter‐related capabilities and functionings.