Marta Szabat

Lawrence J Masek argues that the dead donor rule (DDR) cannot be theoretically justified without also condemning various widely accepted medical practices, such as kidney and partial liver donation, fetal surgery, domino transplants and lethal palliation.1 He offers an internal critique, contending that the principles used to defend the DDR—‘do no harm’, ‘do not kill’ and the doctrine of double effect—either overreach or become inconsistent. Masek’s argument is based on contentious assumptions about moral symmetry, intention and the nature of harm. These assumptions trivialise significant moral distinctions and cloud the ethical framework of end-of-life care and organ donation. I would argue that the DDR is not an incoherent remnant of transplant ethics, but rather a substantive moral boundary based on the difference between allowing death and exploiting it for medical benefit. Masek’s critique of the principle of ‘do no harm’ is extensive. If serious and permanent harm is impermissible unless it benefits the patient, then kidney donation and fetal surgery would be prohibited. As these are not prohibited, he concludes that harm-based defences of the DDR are unstable. However, this argument treats harm as a univocal category, which it is …

This systematic review aims to raise awareness of the concept of parental hope, which is distinct from the idea of agency – acting on behalf of someone else. Parental hope is an important factor in end-of-life care, particularly in light of recent advances in perinatology, neonatology, and paediatric palliative care (PPC). Parenting involves autonomous agency – acting and thinking on one's own behalf – as well as making decisions for one's children. Consequently, parental permission, authority and decision-making are integral aspects of parental attitudes towards their children in PPC. To our knowledge, this is the first systematic review to focus specifically on the ethical implications of parental hope in PPC. A qualitative systematic review utilising Charmaz’s initial and focused coding of constructing grounded theory. A systematic search was conducted across two databases: Web of Science and Embase. The research period was from 01/01/2014 to 20/02/2025. Two reviewers independently screened articles against the eligibility criteria and appraised them using CASP critical appraisal tools. Sixty studies met the inclusion criteria and were analysed using initial and focused coding, with the results presented in diagrams. The results were reported in the PRISMA protocol. Key findings included identifying parental hope in PPC as a valuable area of future ethical research, given the various dilemmas involved and the potential advantages for parents of developing their caregiving skills for their children. The results of the four themes (‘False and realistic versus unrealistic parental hope’, ‘Evolution of parental hope as a child’s illness progresses’ with 17 sub-themes, ‘Parental hope and decision-making in PPC’, and ‘Social and structural determinants of parental hope’) were presented in four conceptual diagrams. The results reveal the preference of parents for honest encouragement over false hope. Furthermore, parents can use hope as a cognitive heuristic to influence their decision-making process. Parents also expect clinicians to understand their situation and help them manage their hopes while respecting parental authority. Ethical concerns include equitable access to support programmes and online groups that aid parental caregiving. We believe that the moral beliefs expressed by parents in our review could inform values and standards for parents as caregivers in PPC.

In this paper I discuss the issue of responsibility based on the concept of autonomy within the framework of James Griffin’s concept of personhood. All the examples on which this text is based come from the report Woman Alone: The fight for survival by Syria’s refugee women by the UN Refugee Agency (UNHCR). In the three parts of the article I analyse, first, the agent’s capacity of being responsible in the perspective of autonomy as some sort of capacity of agency as well as a possible personal virtue. In this section, I intend to show in which conditions autonomous responsibility can emerge in the context of Harry Frankfurt’s concept of caring as well as in the situation of refugee women who are responsible for their children and families. The second part of the paper concerns the issue of knowledge and the role which this factor plays in being a responsible agent. The essential conclusion to be drawn from this issue is that autonomous responsibility is not a static virtue. In contrast, very often the agent must act instinctively for being responsible in his or her own way. The third and final part develops the subject of the internal capacity to defend the agent’s interests, needs and desires. Without this power, the agent could not realise his or her own purposes as well as those of the persons for whom he or she takes responsibility. The issue of autonomous responsibility develops Griffin’s normative statement on agency and can be treated as an introduction to the issue of autonomous responsibility as such.

Cardiac xenotransplantation has an experimental status with great potential to become an alternative treatment for patients who are ineligible or waiting for a transplant. In this commentary, I discuss the first three multi-criteria approaches to patient selection presented by the authors to identify a primary target group of patients who could benefit from this therapy. The first criterion concerns adult patients with end-stage organ failure who have a high ‘medical need’ for xenotransplantation as an alternative treatment option. The authors limit their argument to patients for whom ventricular assist devices and artificial hearts are contraindicated and who have no chance of being placed on the transplant list due to comorbidities, acute decompensation or complex congenital heart disease (CHD).1 These patients could be considered for xenotransplantation. However, given the high risk of failure of this experimental treatment and the excessive burden on the patient’s health, the procedure is permitted only in extremely rare situations such as those of Bennett (2022) or Faucette (2023)2 discussed …

The concept of ethical preparedness (EP), defined as a set of practices in genomic medicine aimed not only at efficiently managing sensitive issues in the laboratory but also at ensuring adherence to ethical principles,1 has potential benefits for clinical laboratory scientists, contingent on three key conditions. First, fostering cooperation and mutual support between commercial and non-commercial laboratories in cases involving moral dilemmas or the uncertain nature of variants identified in the laboratory is crucial for establishing the best practices in genomic medicine. Medical codes emphasise regulations aimed at maintaining the authority of colleagues and avoiding patient and family misunderstandings, as well as promoting a culture of mutual trust and support within the medical profession.2 Such practices among laboratories would benefit both patients/clients and scientists. The important thing is to recognise that while laboratory results may possess prospective value for future generations, genomic medicine addresses the clinical needs …

The study discusses a new approach to parental agency in pediatric palliative care based on an active form of caregiving. It also explores the possibility of a positive conceptualization of parental agency in its relational context. The paper begins with an illustrative case study based on a clinical situation. This is followed by an analysis of various aspects of parental agency based on empirical studies that disclose the insufficiencies of the traditional approach to parental agency. In the next step, parental agency is analyzed from a reality‐based perspective as an activity focused on relationships and the cognitive capacity of parents vis‐a‐vis their seriously ill children. The paper also considers the importance of the cultural and social contexts in which parental agency and decision‐making take place. This agency is addressed not as individualistic in form, and nor is it exercised in terms of fixed choices. Rather, the focus is on its dynamic and future‐oriented aspects. Consequently, parental agency should be comprehended not only as a form of proxy agency representing the child's best interests but also as a complex decision‐making process in which the parents learn from their child how to become good, compassionate caregivers and at the same time good parents.

This article examines the compatibility and relevance of Gabriel Marcel’s phenomenology of hope in interdisciplinary research on the role of hope in end-of-life care. Our analysis is divided into three thematic topics which examine the various shades of hope observed in Marcel’s phenomenology of hope and in the collection of 20 EOL studies on hope as experienced by adult palliative care patients, health care professionals and parents of terminally ill children. The three topics defining the shades of hope are: the meaning of hope in its dynamic aspects, the dialectics of hope and despair, and the transcendent facets of hope. We analyse how Marcel’s understanding of hope is reflected in EOL studies, and how this perception can enrich the philosophy of PC and significantly deepen and broaden HCPs’ understanding of hope. Our findings prove that despite terminological differences between Marcelian phenomenology and the concepts of hope in the 20 EOL studies, hope emerges as a resourceful movement towards being. Implementing Marcelian hope within communication in EOL care could help in HCPs’ interpersonal approach to patients as his concept harbors a holistic perception of the existential situation of a person. Equally, introducing Marcel’s phenomenology of hope into the clinical encounter could play a beneficial role in improving the ability of patients to adapt to the difficult conditions of their disease and PC treatment.

This article concerns events of the Old Testament – Yahweh commands Abraham to sacrifice his only son – Isaac – on Mount Moriah. This passage from the Old Testament, from the Book of Genesis, became the basis of Søren Kierkegaard’s considerations in Fear and Trembling. In the text I refer to, on the one hand, Kierkegaard’s considerations, while on the other hand I try to identify other possible interpretive tropes that could be useful, for example, during classes on the subject of faith or the status of ethical dilemmas in the modern world.

The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care.

The paper is devoted to the development of Emmanuel Lévinas’ philosophy of the subject as expounded in his Autrement qu’être ou au-délà de l’essence. Levinas claims that the subject is good but emerges from a formless substrate; for this reason it belongs to something which can described as anonymous, dark, ignorant, sensual — the otherness. An attempt to define the structure of the subject as an abstract entity is only possible in virtue of the fact that its form has been separated from something that is difficult not only to describe but also to understand, even by intuition. In this sense one may say that the subject discovers itself as the Other. The subject discovers its own belonging to the Otherness which precedes the process of becoming its own. Finally, the subject knows that the only way to be Itself is to take responsibility for the otherness through which it establishes its subjectivity as such