David Kirchhoffer

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.

Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of human persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity.

Abstract Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of human persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity.

Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in times of critical care resource shortages. Dignity affirms the worth of the human individual as a meaning-making embodied subject, who is always in relationship to others, the world, time, and transcendence, and who realizes their dignity through their moral behaviour. Such an understanding means people should be helped to make morally right decisions about their own treatment, which may include forgoing potentially beneficial treatment for the good of others. Respect for dignity does not require fulfilling the morally wrong choices of one who insists on treatment at the expense of others. Dignity also protects the discretion of clinicians to make decisions appropriate to their competence by prohibiting the application of broad-based criteria such as age.

The use of voluntary assisted dying as an end‐of‐life option has stimulated concerns and debates over the past decades. Although public attitudes towards voluntary assisted dying (including euthanasia and physician‐assisted suicide) are well researched, there has been relatively little study of the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. Using a mix of computational textual mining techniques, keyword study and qualitative thematic coding to analyse public submissions to a parliamentary inquiry into voluntary assisted dying in Australia, this study critically examines the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. The analysis identified complex and potentially contradictory ethical principles being invoked on both sides of the debate. These findings deepen our understanding of the moral basis of public reasoning about end‐of‐life matters and will help to inform future discussions on policy and law reform. The findings underscore the importance of sound normative reasoning and the use of caution when interpreting opinion polls to inform policy.

Human Dignity in Contemporary Ethics develops a holistic and relevant understanding of human dignity for ethics today. Whilst critics of the concept of human dignity call for its dismissal, and many of its defenders rehearse the same old arguments, this book offers an alternative set of methodological assumptions on which to base a revitalized and practical understanding of human dignity, which at the same time overcomes the challenges that the concept currently faces. The Component Dimensions of Human Dignity model enables human dignity to serve both as a descriptive category that explains moral choices, and as a normative criterion that helps to evaluate moral behaviour. A consideration of two cases--violent crime and physician-assisted suicide--demonstrates how the model offers a way to avoid the pitfalls of both moralism and moral relativism, while still leaving space for relativity in ethics. By using an approach that should be acceptable to both religious and secular perspectives alike, this book offers a unique way out of the 'dignity talk' that currently plagues ethics.

The threat of ecological collapse is increasingly becoming a reality for the world’s populations, both human and nonhuman; addressing this global challenge requires enormous cultural creativity and demands a diversity of perspectives, especially from the humanities. Theology and Ecology Across the Disciplines draws from a variety of academic disciplines and positions in order to explore the role and nature of environmental responsibility, especially where such themes intersect with religious or theological viewpoints. Covering disciplines such as history, philosophy, literature, politics, peace studies, economics, women’s studies, and the ecological sciences as well as systematic and moral theology, the contributors emphasize how these positions have begun to develop distinct perspectives on urgent ecological issues, as well as pointing toward specific practices at the local and international level. This volume provides a multidisciplinary point of departure for urgent conversations on environmental responsibility that resist simplistic solutions. Rather, the contributors highlight the complex nature of modern ecology, and suggest creative ways forward in the situation of an apparently intractable global problem.

The concepts of personhood and human dignity are widely used in contemporary healthcare ethics. This chapter provides a brief overview of how the concept of human dignity came to be so important in healthcare ethics, and examines how the concept’s widespread use and relationship to the concept of personhood have led to problems regarding its meaning and relevance. A practical solution is then presented. The rise of the concept of human dignity in healthcare ethics The word dignity is derived from the Latin dignus, which means worthy. Since dignity refers to worth, human dignity refers to the worth of the human. What makes the concept of human dignity important for ethics is that, unlike the dignity of a queen or the dignitaries at an awards ceremony, which expresses the worth or status of particular human individuals in relation to others, human dignity is meant to express a worth that is equally shared by all human individuals. It is not meant to be dependent upon their social status, economic wealth, race, gender or anything else. Moreover, it is meant to affirm a worth beyond price. Human individuals are said to be moral goods or ends in themselves, not merely good or useful as means to achieving other ends.

Summary This volume undertakes to determine the fundamentals and limits of an ethical assessment of the methods of modern medical technology with regard to the concepts of human dignity and human image, which are particularly important for this purpose. It shows that the philosophical-legal foundation of the term human dignity has not yet been clearly clarified; one even has to ask whether the term is (still) suitable for assessing ethical problems in medical technology. The term human image also needs clarification and clarification in order to be taken seriously as a topos in the medical ethical discussion. The volume emerged from the work of an interdisciplinary and international research group at the Center for Interdisciplinary Research (ZiF), Bielefeld. It deals primarily with the theoretical foundation of the terms human dignity and human image and is supplemented by a volume, the contributions of which illustrate the problems of practice using examples from different areas of medical technology.

What does it mean to be human? The traditional answers from the past remain only theoretical possibilities unless they come to mean something to today's generation. Moreover, in light of new knowledge and circumstances, a new generation may call these old answers into question, and seek to reinterpret, or, indeed, provide alternatives to them. In the 1960's, the Catholic Church's Second Vatican Council attempted such a reinterpretation, an aggiornamento, for the post-war generation of the mid-twentieth century by proposing, in Gaudium et Spes, a theological anthropology founded upon the ideas of human dignity and the common good. Fifty years later is an appropriate time to revisit those answers, and to seek again to reinterpret or provide alternatives to them, in light of new knowledge for a new generation. Taking the themes of Gaudium et Spes as its starting point, this book looks at developments in theology and philosophy in the latter half of the twentieth century that call some of these 'old' answers into question. It identifies some of the 'new knowledge and circumstances' that need to be taken into account for this generation's answer to the question of what it means to be human. In five parts, leading philosophers and theologians ¥ offer interpretive lenses for reading the theological anthropology of the twentieth century; ¥ address the challenges of anthropocentricism, alterity, incarnation, and postmodernity for the notion of the human subject; ¥ tackle the important moral concepts of conscience, responsibility, evil and guilt; ¥ investigate the claims of atheism, fundamentalism, scientific naturalism, nihilism, and pluralism; and ¥ consider questions of the relationship between the individual and the community in the modern secular state. In so doing, this book prepares the ground for the development of a theological anthropology for the twenty-first century.

This chapter examines the explicit and implicit roles that the concept of beneficence plays in the guidelines that govern biomedical research involving humans. We suggest that the role beneficence is actually playing in the guidelines is more comprehensive than is commonly assumed. The broader conceptualisation of beneficence proposed here clarifies the relationship of beneficence to respect for autonomy. It does this by showing how respect for autonomy is at the service of beneficence rather than in tension with it.

This book makes an important contribution to ongoing efforts in the fields of medical law and bioethics to answer the challenges posed by the limitations of the principle of respect for autonomy, especially as these pertain to human research ethics. The principle of respect for autonomy seems to have become firmly embedded in human research ethics since its inclusion in the 1947 Nuremberg Code, which was a response to atrocities committed by Nazi doctors. Nonetheless, there is an increasing awareness of the limitations of the principle of respect for autonomy and the underlying conceptualisations of human autonomy.

With a challenging title, based on an anecdote about a dialogue between a scientist/philosopher and a lady on the structure of the universe, David Kirchhoffer proposes that the insight that human beings are the world (rather than merely live in the world) should be our starting point for reflections on theological anthropology. Relationality thus being the key-word for an up-to-date theological anthropology, this chapter discusses the main challenges that such an anthropology faces: first, anthropocentrism (challenged by the ecological crises, the debate on who counts as a person and technology); second, historicity (as introduced by social-constructivism and as taken more seriously in the Christian tradition in recent decades); third, vulnerability (as a morally neutral consequence of our interdependency); and finally, language (as a means to engage with diverse discourses ranging from art through to philosophy,business and cognitive neuropsychology). More than claiming to know the solutions for these different challenges, Kirchhoffer rather encourages theologians to further reflect on them and the way they are discussed in theological and other discourses with a necessary (self-)critical epistemological suspicion. For only in this way will we arrive at a relevant theological discourse on what human beings are, and be a legitimate dialogue partner for other discourses.

Since the end of World War II, most guidelines governing human research seem to have relied on the principle of respect for autonomy as a key, though not sole, criterion in assessing the moral validity of research involving human participants.1 One explanation for this apparent reliance on respect for autonomy may be that respect for autonomy, made effective through the practice of obtaining informed consent, functions as a useful proxy when dealing with competent adults for the more complex principle of respect for human dignity that underpins much of the moral discourse in this area. If this explanation holds, then assessment of the moral licitness of research involving human individuals whose autonomy is limited in some way requires a deeper analysis of the ‘thicker’ concepts of human dignity, since we cannot rely on respect for autonomy to do the work of respect for human dignity where autonomy (understood as a capacity to consent based on adequate information) is not present, is limited or is compromised.

This book makes an important contribution to ongoing efforts in the fields of medical law and bioethics to answer the challenges posed by the limitations of the principle of respect for autonomy, especially as these pertain to human research ethics. The principle of respect for autonomy seems to have become firmly embedded in human research ethics since its inclusion in the 1947 Nuremberg Code, which was a response to atrocities committed by Nazi doctors. Nonetheless, there is an increasing awareness of the limitations of the principle of respect for autonomy and the underlying conceptualisations of human autonomy.

Respect for autonomy has become a fundamental principle in human research ethics. Nonetheless, this principle and the associated process of obtaining informed consent do have limitations. This can lead to some groups, many of them vulnerable, being left understudied. This book considers these limitations and contributes through legal and philosophical analyses to the search for viable approaches to human research ethics. It explores the limitations of respect for autonomy and informed consent both in law and through the examination of cases where autonomy is lacking (infants), diminished (addicts), and compromised (low socio-economic status). It examines alternative and complementary concepts to overcome the limits of respect for autonomy, including beneficence, dignity, virtue, solidarity, non-exploitation, vulnerability and self-ownership. It takes seriously the importance of human relationality and community in qualifying, tempering and complementing autonomy to achieve the ultimate end of human research - the good of humankind.

Human dignity has long been used as a foundational principle in policy documents and ethical guidelines intended to govern various forms of biomedical research. Despite the vast amount of literature concerning human dignity and embryonic tissues, the majority of biomedical research uses non-embryonic human tissue. Therefore, this contribution addresses a notable lacuna in the literature: the relationship, if any, between human dignity and human tissue. This paper first elaborates a multidimensional understanding of human dignity that overcomes many of the shortcomings associated with the use of human dignity in other ethical debates. Second, it discusses the relationship between such an understanding of human dignity and ‘non-embryonic’ human tissue. Finally, it considers the implications of this relationship for biomedical research and practice involving human tissue. The contribution demonstrates that while human tissue cannot be said to have human dignity, human dignity is nevertheless implicated by human tissue, making what is done with human tissue and how it is done worthy of moral consideration

The claim that human dignity is universal is challenged by the particular experience of the horrible things people do to others. If dignity is just a ‘vacuous concept’ then the notion of universal human rights and the claim of cosmopolitism that all human beings for a single moral community are also called into question. A close reading of the Universal Declaration of Human Rights and an analysis the historical development of the text reveals a complex conception of human dignity expressed by the Component Dimensions of Human Dignity model. The model conceives of human dignity in terms of four Component Dimensions – existential, behavioral, cognitive-affective and social- each consisting of a Complementary Duality comprising two facets held in tension along an axis of the Already and the Not Yet. Consequently, human dignity can be understood both as Already a universal truth, and as Not Yet realized in every particular life.

Biobanking policy needs to take into account the concept of human dignity, because this concept is enshrined in both international and South African law. The accepted understanding of informed consent, which is also required by law, is inadequate for biobanking because it is often not possible to inform people of possible uses of their stored tissue. If human dignity is understood as a multidimensional concept that corresponds to the multidimensionality of the human person, then human dignity can be said to be both (i) something that all people already have, as an inviolable worth that inheres in their potential to live meaningful lives; and (ii) something that people seek to realize through morally good behavior in historically-situated relationships. This understanding of human dignity can be used as both an interpretive lens and a normative vision. It is interpretive because it reveals how various attitudes to biobanking and the various proposed consent regimes--presumed, broad, and specific--might all be underpinned by appeals to human dignity. It is a normative vision because, given that all of these positions can be underpinned as morally meaningful with respect to human dignity, provision should be made for all of the possible consent regimes in law and in biobanking practice. Nonetheless, where compromise cannot be avoided, then, at the very least, human dignity understood as the human potential to live a meaningful moral life must be protected.

The claim that human dignity is universal is challenged by the particular experience of the horrible things people do to others. If dignity is just a ‘vacuous concept’ then the notion of universal human rights and the claim of cosmopolitism that all human beings for a single moral community are also called into question. A close reading of the Universal Declaration of Human Rights and an analysis the historical development of the text reveals a complex conception of human dignity expressed by the Component Dimensions of Human Dignity model. The model conceives of human dignity in terms of four Component Dimensions – existential, behavioral, cognitive-affective and social- each consisting of a Complementary Duality comprising two facets held in tension along an axis of the Already and the Not Yet. Consequently, human dignity can be understood both as Already a universal truth, and as Not Yet realized in every particular life.

The rise of “dignity talk” has led to the concept of human dignity being criticized in recent years. Some critics argue that human dignity must either be something we have or something we acquire. Others argue that there is no such thing as human dignity and people really mean something else when they appeal to it. Both “dignity talk” and the criticisms arise from a problematic conception of medical ethics as a legalistic, procedural techne. A retrieval of hermeneutical ethics, by contrast, offers a way to overcome both the legalism of contemporary ethics and the abuses and criticisms of the concept of human dignity. Such an ethics affirms both the inherent dignity of a human being as a multi-dimensional, meaning-seeking, historically-situated, relational individual, who desires to live a good life, and the realized sense of his/her own dignity toward which s/he works. As such, human dignity cannot be reduced to one feature of the human, and instead functions as both a descriptive category that avoids moralism, and as a normative category that allows relativity whilst avoiding relativism. Content Type Journal Article Category Article Pages 141-154 DOI 10.1558/hrge.v17i2.141 Authors David G. Kirchhoffer, School of Theology, Australian Catholic University, PO Box 456, Virgina QLD, 4014 Australia Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 17 Journal Issue Volume 17, Number 2 / 2011

The concept of human dignity is widely used in contemporary ethics and law as a foundational criterion for moral reasoning. Nonetheless, the concept has recently received criticism from various quarters. Some of this criticism has come from representatives of the animal liberation movement. The concept of human dignity is accused of underpinning an ethics that is anthropocentric and speciesist. That is, human dignity is said to be used as the basis of an ultimately unjustifiable attribution of intrinsic moral worth only to human beings and to lead, consequently, to a detrimental prejudice against other species.

In the debates concerning the ethics of human enhancement through biological or technological modifications, there have been several appeals to the concept of human dignity, both by those favouring such enhancement and by those opposing it. The result is the phenomenon of ‘dignity talk', where opposing sides both appeal to the concept of human dignity to ground their arguments resulting in a moral impasse. This article examines the use of the concept of human dignity in the enhancement debates and reveals that the problem of dignity talk arises because proponents of various positions tend to ground human dignity in different features of the human individual. These features include species-membership, possession of a particular capacity, a sense of self-worth, and moral behaviour. The article proposes a solution to this problem by appealing to another feature of human beings, namely their being-in-relationship-over-time. Doing so enables us to understand dignity as a concept that affirms the worth of human individuals as complex, multidimensional wholes, rather than as isolated features. Consequently, the concept of human dignity can serve both a descriptive and a normative function in the enhancement debates. At a descriptive level, asking what advocates of a position mean when they refer to human dignity will reveal what aspects of being human they deem to be most valuable. The debate can then focus on these values. The normative function, although it cannot proscribe or prescribe all enhancement, approves only those enhancements that contribute to the flourishing of human individuals as multidimensional wholes.

It has been said that human dignity is a vacuous concept that should, therefore, be dismissed as an ethical category. This article seeks to defend the concept of human dignity by suggesting, first, that the flaw in the logic of those who claim that human dignity is a vacuous concept lies in an unjustifiable reductionism that results from the hermeneutic of suspicion that such authors apply to the concept. Second, that human dignity is not an either/or concept, as these authors would suggest, but rather a both/and concept in which the contradictions that they would use for its dismissal are indeed where human dignity’s value as an ethical category lies. This is achieved by applying both a hermeneutic of suspicion and a hermeneutic of generosity to a reading of Gaudium et Spes. The result is a heuristic of human dignity in which dignity is shown to be something that all human beings all already have and, at the same time, still seek to acquire through morally good behaviour. The Component Dimensions of Dignity model addresses this tension in various aspects of the human condition: existential, behavioural, cognitive, and social. In so doing it provides a heuristic tool that can serve both a descriptive and a normative function in ethical discourse, because it can help us to see not only why people may engage in a particular course of action but also the extent to which this action really meets the proviso of the social component dimension of the model, namely, that my dignity is only ever fulfilled if the dignity of all others is brought to fulfilment

Australians responded enthusiastically to the calling of the Synod, though there appears to be a tension between expectations of doctrinal reform and pastoral reform. The Bishops Conference allowed each diocese to consult as it saw fit and submit its findings, in light of which a committee of four bishops drafted the official submission to the Synod. Other materials were also sent to the Synod office, including some directly by dioceses and other Catholic organisations. The dioceses surveyed made the preparatory document and questionnaire available online and in print. There was a high level of frustration expressed with the complexity of many of the questions. The Conference and most dioceses did not publish the findings of the consultation or their submission to the Synod. Nonetheless, these are likely to reveal trends with regard to co-habitation, pre-marital sex, contraception, the treatment of divorced Catholics and same-sex marriage similar to those of other western countries based on an analysis of existing quantitative data from the National Church Life Survey, diocesan reports to which the researchers were given access, and the Catholic media. There is an apparent disconnect between the lived experience of many Catholics and Church teaching in these areas. Moreover, there is a tension between issues of doctrinal confusion, doctrinal rejection, and pastoral care which could have consequences for whether the Synod should consider doctrinal reform or need only focus on pastoral care. Most importantly, the responses demonstrate that Catholics in Australia want to be better informed about Church teaching, want to be consulted about these matters, and want to have a say in the formulation of Church teaching. Not taking these wishes seriously risks further alienating many Catholics from the Church who express a disjuncture between Church teaching and their own life experience in these matters.