The case of nonvoluntary euthanasia shows that the current definition of euthanasia must be more accurately determined. Euthanasia refers necessarily to the ending of life due to serious illness which must be expanded to include the lack of any capacity to give sense to life. A person in this latter position would be under lasting and unbearable suffering, perhaps unconscious, and incapable of leading her own life. The ethics of euthanasia must take these considerations into account. The will does not found the ethical decision. This is based instead on the reasonableness of continuing life under these circumstances. Voluntary euthanasia, as well as nonvoluntary, is founded on the right that every person who suffers under these conditions has to put an end to her life. It is understood that this is the only way to escape from such misfortune when life does not make sense any longer. The topic of euthanasia has a political dimension that is associated with the contemporary practice of medicine and the defense of human rights in our society. At the foundational level, euthanasis is unitary; the distinction between voluntary and nonvoluntary establishes only further precision, not a fundamental one.

The ecofeminist critique of dualism is applied to a consideration of two alternative paths that we might take in transplantation medicine: the utilization of organs and tissues taken from nonhuman animals, and/or further development of techniques for employing human organs and tissues, including human fetal tissue. It is concluded that from an evolutionary perspective, the assumption of a vast value disparity between human and nonhuman life is untenable, and from a moral point of view the establishment of yet another institution based on a dualistic opposition between human life, postulated to be of ultimate value, versus devalued, disposable "other" life is unacceptable. We are urged to forego xenotransplantation and instead take responsibility for whatever manipulations we choose, respectfully, to make with life that is already valued as "self" rather than "other."

Recent developments in biology have made it possible to acquire more and more precise information concerning our genetic makeup. There are four groups of people who may want to know about our genes. First, we ourselves can have an interest in being aware of own health status. Second, there are people who are genetically linked with us, and who can have an interest in the knowledge. Third, individuals with whom we have contracts and economic arrangements may have an interest in knowing about our genetic makeup. Fourth, society as a whole can have an interest in the composition of our genes. As regards the question of motivation, the term ‘should’ can be interpreted in three ways. Prudentially speaking, to say that individuals should act in a certain manner is to say that the actions in question promote the longterm self-interest of these individuals. From the viewpoint of morality, we should do what is right and avoid doing what is wrong. When it comes to legal thinking, it is held in most liberal societies that grave other-regarding harm should be the primary justification for the use of coercion and constraint. In the paper, all these aspects are examined in more detail.

Since Alasdair MacIntyre’s landmark book After Virtue, there has been renewed interest in the role of the virtues in the moral life and attention paid to reappropriating the Aristotelian notion of "practice." Recent reappropriations of the virtues and virtue theory in medical ethics have contributed to conceiving more adequately the nature of good medicine. I wish to explore some of these insights and the special relevance the notion of practice has in an account of good medicine. Yet, I also want to suggest that much remains to be done. This renewed attention to the virtues needs to be supplemented by a similar reappropriation and transposition of the notion of nature in order to navigate successfully the Dardanelles of an ahistorical essentialism and the Bosphorus of a historical relativism.

There are many risks involved in genetic engineering. The release of genetically altered organisms in the environment can increase human suffering, decrease animal welfare, and lead to ecological disasters. The containment of biotechnological material in laboratories and industrial plants contributes to the risk of accidental release, especially if the handling and storage are inadequate. The purely political dangers include intensified economic inequality, the possibility of large-scale eugenic programs, and totalitarian control over human lives. How should the acceptability of these risks be determined? We argue that the assessment should be left to those who can be harmed by the decisions in question. Economic risks are acceptable, if they are condoned by the corporations and governments who take them. The risks imposed on laboratory personnel by the containment of dangerous materials ought to be evaluated by the laboratory personnel themselves. All other risks are more or less universal, and should therefore be assessed as democratically as possible. If risk-taking is based on the choices of those who can be harmed by the consequences, then, even if the undesired outcome is realized, the risk is acceptable, because it is embedded in their own system of ethical and epistemic values.

Helping people to die may involve killing and/or alleviation of pain in a dying person. A dual commitment to the avoidance of killing and the alleviation of pain raises the question of whether these two ways of helping people are always compatible. This paper addresses the question through use of sources in classical American pragmatism and contemporary bioethics. First, I apply Charles Peirce’s notion of pragmatism to the concept of killing through consideration of the empirical consequences of alternative interpretations. James Rachels’ account of the distinction between active and passive euthanasia is critiqued in this analysis. Second, I examine what it means to relieve pain by relating Jane Addams’ concept of maternal nurturance to an ethic of care and opposition to killing. Utilizing these concepts, I apply William James’ notion of pragmatism as a method of mediating or straddling different theoretical approaches to resolve the apparent incompatibility between pain relief and the avoidance of killing. To address social concerns raised by the practice of helping people to die, I propose a corrective insight of Addams, along with John Dewey, about the role of the philosopher as social critic. Thus understood, pragmatism is a means of avoiding abuses that may occur in the process. I conclude that so long as permissive practices are restrained sufficiently to avoid injustices, it is morally both possible and desirable to resist killing while relieving pain.

La determinación genética permite establecer que personas tienen mayor probabilidad de padecer enfermedades degenerativas o tumores. El problema ético se suscita cuando se utilizan las determinaciones para elegir personas con baja probabilidad de padecer enfermadades para que desarrollen actividades. En el análisis, cabe la posibilidad de estudiarlo desde el punto de vista antropológico y desde el punto de vista bioético. Desde el punto de vista antropológico, cuando se produce una discriminación de las personas en relación a su carga genética, no se tienen en cuenta la biografía y el proyecto de la persona (sólo se considera el aspecto animal), la relación entre la persona y la sociedad sufre deficiencias por considerarlo instrumento, y la relación médico enfermo es defectuosa. Desde el punto de vista bioético, la discriminación no cumple los principios bioéticos del primer nivel, que son de obligado cumplimiento, y los del segundo, también se encuentran insatisfactoriamente cumplidos. Mejorando la relación médico enfermo y sus valores de confidencialidad y veracidad pueden realizarse mejor los aspectos bioéticos.

I examine the ways in which our cultural expectations with respect to death may be transformed by the legalization of assisted suicide. I suggest the inadequacy of the philosophical framework currently taken as the basis for discussing the advantages as well as the dangers of legalizing assisted suicide. I do not believe that individual autonomy is any sort of possibility for dying patients, regardless of the social policies that surround death in a society, insofar as our individual agency in this situation is necessarily intertwined with that of various relevant others. By means of a theory of agency relations, I attempt to show the dynamic ways in which we may all adjust to the option of assisted suicide as a preferred end-of-life option. My theory of agency relations does not deny individual choice; rather it explains the qualitative complexity of individual choice, as well as its dynamic social process of evolving.

I will analyze the links that have been established between sexuality and death in the social representation of AIDS, formerly expressing the silent agreements in the "risk groups" category. The increasing number of women infected with the HIV virus reveals that for individuals who do not identify themselves within the "risk group" category, AIDS is "someone else's" illness. To make this hypothesis explicit, I will start with an interview with former basketball player "Magic" Johnson who in 1991 publicly announced that he was HIV positive. In a sentence, Johnson revealed the significance of social discourse about AIDS in the eighties: "Now we are talking about life and death . . . AIDS was for me a gays and drug-addicts disease, formerly, not of a person like me." This revelation of an American idol showed that the HIV virus had reached those who identified themselves as heterosexuals. What happened after this announcement? The first response was to identify individuals who behaved bisexually, as their contagion certainly would have happened as a result of relations with the "risk group." This imaginary identification of sexual behaviors served to sustain the social representation of AIDS as a disease of marginal groups.

How may children and other dependent individuals are subjects in research projects to which they cannot consent and from which they cannot benefit? This topic was much discussed in the United States about twenty-five years ago, but has recently reemerged in the discussion of the European Convention on bioethics and through current discussion in the medical literature of the kinds of consent and experiments appropriate in the Third World. I summarize the U.S. discussion and "solution," present the current European discussion, and conclude with a proposal for understanding and organizing the participation of dependent people in medical experiments. Most of the attempts to understand dependent individuals’ participation in nontherapeutic experiments have attempted to assimilate that participation to a model of informed consent appropriate for adults. I argue that such understanding is false to the nature both of dependency and non-therapeutic experiments. The dependency of childhood, which serves my model, is best viewed in the context of a family committed to the full development of children. Given that commitment, the family involves itself in many activities in the hope of the physical, intellectual and moral development of its members. Non-therapeutic experiments are best seen, not in terms of risk, but in terms of the time and energy commitments they require of participants. Given these understandings of dependency and non-therapeutic experiments, I argue that care-givers are competent to involve themselves and their dependents in scientific work.

My purpose is to initiate a discussion of the ethics of implanting computer chips in the brain and to raise some initial ethical and social questions. Computer scientists predict that within the next twenty years neural interfaces will be designed that will not only increase the dynamic range of senses, but will also enhance memory and enable "cyberthink" — invisible communication with others. This technology will facilitate consistent and constant access to information when and where it is needed. The ethical evaluation in this paper focuses on issues of safely and informed consent, issues of manufacturing and scientific responsibility, anxieties about the psychological impacts of enhancing human nature, worries about possible usage in children, and most troubling, issues of privacy and autonomy. Inasmuch as this technology is fraught with perilous implications for radically changing human nature, for invasions of privacy and for governmental control of individuals, public discussion of its benefits and burdens should be initiated, and policy decisions should be made as to whether its development should be proscribed or regulated, rather than left to happenstance, experts and the vagaries of the commercial market.

Today, biology is instrumental in the epistemological restructuring of the human sciences. This ‘biology,’ however, does not signify the body itself, but a metaphorical, linguistic construction of the self around which many aspects of contemporary life are becoming organized. The central metaphor of one’s biology is one’s genes, and ‘one’s genes’ are seen as the essence of the person. For complex historical, political and cultural reasons, the human genome is increasingly equated with the ‘essence’ of humanness. But, not only are genetic definitions of humanness, personality and identity the product of a historical discourse, the self they seek to define is a construct to begin with, arising from an essentialist epistemology, and is historically situated itself. Scientists who are involved in human genetics and the human genome project are confronted with this epistemological reconstruction of the self in unique ways, since they find themselves in the roles of the knowers and the known. Any definition of the human self will simultaneously affect the object of their research and their own agency. The issues about moral-agency-of-life scientists that need to be considered in this context can fruitfully be discussed from one postmodernist perspective. Drawing on Foucauldian analysis, Susan Hekman reminds us that no one is ever offered only one discourse. We are self-creating subjects who refuse to be scripted, and create our self out of the many discourses that are available. I will employ aspects of her theory of the discursive subject, and recent perspectives arising from postcolonial science studies, to develop a twofold strategy for transformation in molecular biology.

How philosophy is educating humanity will be explained regarding an actual example concerning the new public health paradigm or health promoting research. The central point of reference is the discussion of the decisive substantiation of the work of medical sociologist, Aaron Antonovsky; his approach to salutogenesis is opposed to the usual approach of pathogenesis. Here, emphasis is put on "Sense of Coherence" (SoC). It will be shown that, in contrast to Antonovsky's original intention, the relation to the natural sciences and scientific medicine is sufficient to substantiate neither his central arguments nor the relation to the continental traditions of philosophy, especially to existential philosophy and to philosophical hermeneutics mentioned in his latest works. Therefore, referring to a prominent sociological representative of modern health science, means-end rationality is no longer able to assert its dominant position in this field, but must be legitimized by value rationality. Antonovsky's concept of SoC also inevitably includes the argument that methodologically oriented explanation (Erklären) of health related problems can never be replaced by sense-oriented understanding (Verstehen).

Nowadays, man possess a power of intervention on nature without precedent, bearing not only upon the physical environment, but also upon the biological environment. In this study we intend to reflect first on the ethical and legal implications of the utilization of "genetic engineering" on plants and animals. On that point of view, we will insist on the issue of the relations between man and nature. Secondly, we will deal with the ways of application of genetic engineering to humans. We will be positioned, not anymore at the level of the relationship that man has with its natural environment, but at that relationship man has with human nature. We will examine the ethical and legal implications of the human genome project (analysis and screening), and of genetic therapy (somatic cells and germinal cells). On that point of view we will insist on the issue of the relations of man, in its singularity, with mankind, in its universality. We will conclude for the affirmation of an indispensable respect for Nature, which builds up as an inalienable ethics, which law institutes as unavoidable obligation.

An organic framework of analysis is not a new or postmodern idea. There have been several versions of an organic paradigm, but the concept generally refers to some application of a classical Greek understanding of human nature as a composite whole. The organic paradigm has often referred to a model of human nature as being a composite of physical, social, mental and spiritual dimensions. This understanding of human nature has sometimes been described as a metaphor because it has been perceived to be like various aspects of the world in which we live. The organic model of human nature was eventually replaced in philosophy because, in an hierarchical Platonic form, it had been used to support hierarchical structures in the Church and the State. Metaphors suggesting organicism in society have also been avoided in our times in part because Hegel extended this to a metaphysical concept of Volkgeist which was subsequently used in part to support a totalitarian nationalism. In the last one hundred years the biological sciences and medicine, however, have not necessarily interpreted the several dimensions of human nature to be hierarchical or ideological. Current interpretation would emphasize a system of checks and balances for health and well-being. A modern ecological version of the organic paradigm, thus remains a very useful framework of analysis for understanding the dynamics of moral and political philosophy, and should be reconsidered.

Moral decisions concerning what ought to be done always assume metaphysical presuppositions concerning the way the world is. In the field of biomedical ethics, some of the metaphysical presuppositions underlying many current discussions of issues of life and death seem particularly implausible. These include our assumption of the reality of social atomism and our beliefs relating to the possibility of autonomy. Given the implausibility of these two assumptions, many discussions have focused our attention on the wrong issues by reducing questions of alternative social practices to questions of individual preferences. Far from facilitating intelligent solutions to our problems, this merely clouds the issues involved.

As a scientific Rapporteur on a European Union Commission Project in the framework of the Research Programme Bio-Med II, I am currently writing a large report on basic bioethical and biolegal principles in Europe. The principles that are investigated are autonomy, dignity, integrity and vulnerability. Against this background, this paper is a clarification of the foundation and significance of these basic principles in bioethics and biolaw. The task of this paper is to elaborate on the philosophical and conceptual framework of these principles. The point of departure is a discussion of the choice of exactly these principles in the context of the law of the human person as well as of the ethical and legal status of the principles. This leads to the definition and explication of each concept and their mutual relations. It is important to emphasize that the principles, rather than being mutually exclusive, are interdependent and imply each other in the protection of human beings in biomedical research and application. Finally, the definition of these principles will be set in relation to social solidarity and responsibility in the modern welfare state where we experience a transformation of the legal system towards an extended notion of state responsibility and a concern and protection of the vulnerable and weak in European societies.

Over two millennia of Western philosophy has not yet contributed much to the education of humanity. Philosophy has almost always been the exclusive domain of a small group of men. This elite character makes the assumption that philosophy could contribute to the education of human beings towards humanity — a humanity of human rights — improbable. If we want to educate human beings towards humanity, we will first have to teach them a sense of responsibility. The power of persuasion needed in order to teach such a sense of responsibility requires that we demonstrate our involvement in and co-responsibility for their concrete problems by presenting clear analyses of these problems and by setting a good example wherever possible. One of the most universal and concrete problems of life is the issue of procreation. As regards this issue, however, philosophers have failed miserably: they themselves have often exhibited irresponsible procreation and have, in fact, only recently begun to consider the issue a subject for philosophy. I will try to analyze when a decision to procreate or abort may be called responsible and whether and to what extent the applications of modern techniques such as in vitro fertilization are in line with our views of human rights.

Prospects of human genetic modification raise the question of genetic enhancement of memory. A moral framework that takes into account the tension between the roles of parent and citizen on the question of genetically enhancing a child’s memory is presented. Weaknesses of both moral liberalism and moral communitarianism are addressed: a tyranny of a powerful minority of liberalism, while a tyranny of orthodoxy and a tyranny of perfectionism plague different forms of communitarianism. A position is advanced that draws on the strengths of both a Rawlsian form of contractarianism and a moderate version of communitarianism. I argue that genetic enhancements of memory in children pose such serious wrongs and threats to general well-being that the practice should be decided from behind a Rawlsian veil of ignorance. With the cards down, as Ronald Green describes the veil of ignorance, a basic right to nondiscrimination on the basis of genotype would be negotiated. With this right in place, conflicts between the parental role and the role of citizen would be managed by the negotiated prohibition of parental decisions genetically to enhance the memory of children.

The distinction between killing and letting die has been a controversial element in arguments about the morality of euthanasia and physician-assisted suicide. The killing/letting die distinction is based on causation of death. However, a number of causal factors come into play in any death; it is impossible to state a complete cause of death. I argue that John Mackie’s analysis of causation in terms of ‘inus factors,’ insufficient but nonredundant parts of unnecessary but sufficient conditions, helps us to see that moral responsibility for death cannot rest on causation alone. In specifying the cause of death, some factors can be considered alternatively as either causal factors or merely parts of the presupposed background conditions. If a factor is moved from the background field into the causal field, the result is a changed background field. Comparisons of cases of killing and letting die often do just this; hence, the cases depend on different presuppositions and the causation cannot be directly compared. Moral judgments determine how to apportion factors to the causal and background fields.