Annette Dufner

Background This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. Argument We argue that sedation is ethically and legally permissible not only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. Conclusion In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly.

A recent organ distribution scandal in Germany raises questions of general importance on which many thousands of lives may well depend. The scandal in Germany has produced reactions that are likely to occur whenever and wherever distribution irregularities occur and become public knowledge. After it had become known that physicians in three German hospitals were in the habit of manipulating records in order to fast-track their patients’ cases, the country experienced a decrease of available organs by a staggering 40% in October 2012. Even though this loss of trust by donors and their families is understandable, and potentially a legitimate form of protest against wrongful distribution, the withdrawal of agreement to serve as a posthumous donor in response to irregularities also inevitably results in avoidable poor outcomes for highly vulnerable individuals. In this paper, we provide a moral analysis of such dilemmas and make recommendations as to the way forward

Michael Quante’s book Person offers a systematic and argumentative assessment of the question what a person is and accounts for the multiple aspects that play a role in our everyday understanding of the term. Quante is skeptical about the possibility of constructing a purely psychological account of the person and proposes to base the diachronic unity conditions of persons on the human organism. At the same time he acknowledges that psychological considerations, including the notion of a person’s personality, are important for practical purposes. However, one may wonder why he proposes the human organism as the remedy for the alleged shortcomings of the psychological approach, rather than introducing an additional physical continuity requirement of the cerebrum or other parts of the brain.

Among the most surprising claims in The Methods of Ethics is Sidgwick’s assertion that his key ethical axioms are corroborated by Kant. This article analyses Sidgwick’s claim that his axioms of justice and benevolence closely correspond to particular features in Kant. I shall argue that his claim of agreement with Kant was a serious overstatement. In particular, the restrictions which Sidgwick places on his acceptance of Kant’s universal law formula of the categorical imperative (FUL) seem to call into question whether the alleged convergence with the axiom of justice has a solid basis. Further, Sidgwick seemed unaware of a crucial aspect of Kant’s conception of the humanity formula that constitutes a substantial divide between their views on benevolence. The upshot is that the divide between Kantian and Sidgwickian ethics appears deeper than Sidgwick seemed to realize. This analysis is confirmed by Sidgwick’s famous worries regarding freedom and the existence of God in Kant’s work.

ZusammenfassungDieser Beitrag befasst sich mit der Befürchtung, dass eine Erweiterung der DNA-Analyse von Tatortspuren für Zwecke der Polizeiarbeit zu Diskriminierungen führen wird. Diese Erwartung bezieht sich insbesondere auf die Ermittlung der sogenannten biogeografischen Abstammung und der Hautschattierung. In dieser Untersuchung werden einige Stellen im Ermittlungsprozess, an denen auf Grundlage solcher Analysen Diskriminierungspotential auftreten könnte, zunächst gesammelt und dargelegt. Im zweiten Teil wird dann der Diskriminierungsbegriff genauer beleuchtet. Dabei wird sich zeigen, dass verschiedene Positionen zu der Frage, was genau eine Diskriminierung moralisch problematisch macht, zu unterschiedlichen Einschätzungen der DNAPhänotypisierung in der Polizeiarbeit führen.

Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID‐19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time‐limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care.

Zusammenfassung Im Falle von Pandemien können die Kapazitäten auf den Intensivstationen bekanntlich knapp werden. In Deutschland hat dieser Umstand zu einem Urteil des Bundesverfassungsgerichts geführt, in dem vom Gesetzgeber verlangt wurde, Menschen mit Behinderungen für solche Fälle besser vor Diskriminierung zu schützen. Aus ethischer Sicht hängt die Frage nach den Diskriminierungspotentialen von Priorisierungskriterien stark davon ab, worin genau das Übel einer Diskriminierung verortet werden muss – eine Frage, zu der es in der Ethik mehrere konkurrierende Theoriegruppen gibt. In diesem Aufsatz soll gezeigt werden, dass diese Theorien darüber hinaus jeweils einer Ergänzung bedürfen, um dem Phänomen der indirekten Diskriminierung gerecht werden zu können. Wie hier am Beispiel einiger konkreter Triage-Kriterien gezeigt werden soll, ist ein Ansatz mittlerer Breite besonders geeignet, um die Aufmerksamkeit auf den Kern der aktuellen Probleme zu lenken. Dazu zählt insbesondere das Ausmaß, in dem soziale Gepflogenheiten gegenüber Menschen mit bereits zuvor bestehenden konkreten Schwierigkeiten generell Auswirkungen auf die Struktur ihrer sozialen Interaktionen haben.

Bettina Schöne-Seifert and Marco Stier present a host of detailed and intriguing arguments to the effect that potentiality arguments have to be viewed as outdated due to developments in stem cell research, in particular the possibility of re-setting the development potential of differentiated cells, such as skin cells. However, their argument leaves them without an explanation of the intuitive difference between skin cells and human beings, which seems to be based on the assumption that a skin cell is merely part of a human organism, while an embryo is at some point a human organism. An appropriately designed concept of the human organism can explain the difference, but also has the potential of re-dividing the argumentative landscape along familiar lines.

There is a widespread consensus that a commodification of body parts is to be prevented. Numerous policy papers by international organizations extend this view to the blood supply and recommend a system of uncompensated volunteers in this area—often, however, without making the arguments for this view explicit. This situation seems to indicate that a relevant source of justified worry or unease about the blood supply system has to do with the issue of commodification. As a result, the current health minister of Ontario is proposing a ban on compensation even for blood plasma—despite the fact that Canada can only generate 30 % of the plasma needed for fractionation into important plasma protein products and has to purchase the rest abroad. In the following, I am going to suggest a number of alternative perspectives on the debate in order to facilitate a less dogmatic and more differentiated debate about the matter. Especially in light of the often over-simplified notions of altruism and commodification, I conclude that the debate has not conclusively established that it would be morally objectionable to provide blood plasma donors with monetary compensation or with other forms of explicit social recognition as an incentive. This is especially true of donations for fractionation into medicinal products by profit-oriented pharmaceutical companies

The paper investigates whether it is plausible to hold the late stage demented criminally responsible for past actions. The concern is based on the fact that policy makers in the United States and in Britain are starting to wonder what to do with prison inmates in the later stages of dementia who do not remember their crimes anymore. The problem has to be expected to become more urgent as the population ages and the number of dementia patients increases. This paper argues that the late-stage demented should not be punished for past crimes. Applicable theories of punishment, especially theories with an appropriate expressivist, or communicative element, fail to justify the imprisonment of the late-stage demented. Further imprisonment would require a capacity for comprehension on the part of the punished, and, under certain narrowly specified conditions, even a capacity to be at least in principle capable of recalling the crime again.

This paper argues that Henry Sidgwick's theory of the good is a form of enlightened preference hedonism. In order to support this conclusion, the paper argues that the correct interpretation of his notorious passage about the 'ideal element' of the good should get tied to his views about weakness of the will. Sidgwick believes that reaching your own good requires overcoming weakness of the will. An applied section illustrates the practical significance of this finding. In cases in which shooting down a passenger plane can save a greater number of people on the ground, and no other relevant considerations apply, the passengers should desire their own destruction-not only to promote the general good, but also in order to reach the only good they can still secure for themselves: giving their inevitable deaths a positive meaning. This utilitarian position regarding some one-versusthe-many cases has been overlooked in the German Supreme Court ruling on the destruction of 9/11 airplanes in 2006

Die zunehmende Verbreitung von Demenzerkrankungen hat zu einem erhöhten Interesse an philosophischen Theorien der personalen Identität geführt, da diese Patienten in manchen Hinsichten aus ihrer eigenen Identität „herauszufallen“ scheinen. Zu den philosophischen Ansätzen, die sich hiermit beschäftigen, gehören Theorien der numerischen Identität, wie etwa das psychologische oder das biologische Kontinuitätskriterium, narrative Theorien der Identität, aber auch Refl exionen über verschiedene Formen des Erinnerns, die sich zum Teil in der modernen Psychologie und in den Neurowissenschaften niederschlagen. Dieses Schwerpunktheft enthält aktuelle Beiträge von Experten aus den genannten Bereichen. ​The increasing number of dementia cases has led to renewed interest in philosophical theories of personal identity, because these patients seem to “drop out” of their own identities in some ways. Philosophical positions that try to account for the phenomenon of identity loss include numerical theories of identity which argue for a psychological or a biological continuity criterion, narrative theories of identity, as well as reflections about different forms of memory, some of which have had influence in modern psychology and in the neurosciences. This special issue brings together current articles by experts in these areas.