Caner Turan

Respect for patient dignity is recognized as an ethical commitment in healthcare, yet the concept often remains too abstract to guide clinical practice. This challenge is salient in mental health contexts, where patients may experience diminished autonomy, stigma, or institutional constraints. This paper develops a conceptual and normative analysis of dignity in mental health care by distinguishing between two conceptions: dignity as inherent worth and dignity-as-standing. Drawing on philosophical analysis, empirical literature, and global policy frameworks, the paper evaluates each conception’s practical implications for care. We argue that while dignity as inherent worth understands dignity as an intrinsic, non-natural value grounding human rights, it often remains too vague to guide clinical decision-making and may risk excluding patients with diminished autonomy. By contrast, dignity-as-standing conceives dignity not as a metaphysical value but as the elevated moral standing of persons that calls for treatment befitting their rank as members of the moral community. This conception offers a more action-guiding and inclusive framework for care, especially for patients with mental illness, disabilities, dementia, or advanced age. On this basis, we identify strategies for operationalizing dignity in practice, including recognizing autonomy as a continuum, implementing supported decision-making, respecting value-based refusals, and embedding relational, structural, and culturally responsive supports in care. The dignity-as-standing framework offers a practical and ethically coherent foundation for respecting patients’ dignity in mental health care, enabling clinicians and institutions to translate the ideal of dignity into concrete practices across diverse clinical and cultural contexts.

Thoracoabdominal normothermic regional perfusion (TA-NRP), a new method of controlled donation after circulatory death, seems to provide more and better organs for patients on organ transplant waiting lists compared to standard controlled donation after circulatory death. Despite its benefits, the ethical permissibility of TA-NRP is currently a highly debated issue. The recent statement published by the American College of Physicians (ACP) highlights the reasons for these debates. Critics’ main concern is that TA-NRP violates the Dead Donor Rule. This paper presents an ethical analysis of the objections raised by the ACP against TA-NRP and argues that TA-NRP is not only morally permissible but also morally required where it is financially and technically feasible. To support this conclusion, the concepts of ‘resuscitation,’ ‘intention,’ ‘irreversibility,’ ‘permanence,’ ‘impossibility,’ and ‘respect’ in the context of TA-NRP are explored. Additionally, the ethical permissibility of this procedure is evaluated through the lenses of Utilitarianism, Kantianism, the core principles of bioethics, and the Doctrine of Double Effect. This ethical analysis demonstrates why the ACP’s objection lacks a solid moral foundation and conflates moral and legal considerations. This paper also argues that extra measures are needed to ensure the moral permissibility of TA-NRP, emphasizing the importance of informed consent, additional brain blood flow and activity monitoring, and a contingency plan to abort the organ procurement process if a sign of morally relevant brain activity is detected.

This paper addresses an important issue that has been commonly debated in moral psychology, namely the normative and metaethical implications of our differing intuitive responses to morally indistinguishable dilemmas. The prominent example of the asymmetry in our responses is that people often intuitively accept pulling a switch and deny pushing as a morally permissible way of sacrificing an innocent person to save more innocent people. Joshua Greene traces our negative responses to actions involving “up close and personal” harm back to our evolutionary past and argues that this undermines the normative power of deontological judgments. I reject Greene’s argument by arguing that our theoretical moral intuitions, as opposed to concrete and mid-level ones, are independent of direct evolutionary influence because they are the product of autonomous moral reasoning. I then explain how both consequentialist and deontological theoretical intuitions, which enable us to make important moral distinctions and grasp objective moral facts, are produced by the exercise of autonomous moral reasoning and the process of cultural evolution. My conclusion will be that Greene is not justified in his claim that deontology is normatively inferior to consequentialism.