Definition of the problemThe medical-ethical principle of beneficence is directed towards the well-being of patients. In clinical practice, the focus is often on the relief of pain, the elimination of symptoms and the restoration of bodily functioning. However, the significance of these health-related aspects for the overall well-being of patients also depends on individual values, desires, and life plans.ArgumentationAn overemphasis on the subjective perspective of patients on their well-being would admittedly lead to a strong substantial convergence of the two medical-ethical (...) principles of beneficence and respect for autonomy. In addition, it would not be compatible with some of the guiding principles of the medical profession. A mere objective perspective on patient well-being conversely carries the danger of imposing values on individual patients that they do not share. Consequently, actions that are intended to benefit patients instead harm them.ConclusionThrough a more detailed analysis of the relationship between health-related and overall well-being, this paper shows that health is only a relative value in our overall well-being. Basic health-related goods like a sound cardiovascular system or fully functioning lungs have special standing because they are seen as valuable independently of individual preferences and life plans, which means they are of objective value. (shrink)

Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in the (...) late stages of Alzheimer’s disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called ‘marginal agents,’ which include young children and patients in the middle stages of Alzheimer’s disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of ‘pre-forms’ of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions – namely, they express the _value_ of autonomy. As I will argue, autonomy is a value worthy of protection and promotion – even in its non-reflexive forms. Against this background, it becomes clear _why_ we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients. (shrink)

There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement technologies. Yet, the search for an adequate and shared understanding of enhancement has always remained an important part of the debate. It was initially undertaken with the intention of defining the ethical boundaries of enhancement, often by attempting to distinguish enhancements from medical treatments. One of the more recent (...) approaches comes from Julian Savulescu, Anders Sandberg, and Guy Kahane. With their welfarist account, they define enhancement in terms of its contribution to individual well-being: as any state of a person that increases the chances of living a good life in the given set of circumstances. The account aims to contribute both to a shared and clear understanding of enhancement and to answering the question of whether we should enhance in certain ways or not. I will argue that it cannot live up to either claim, in particular because of its inherent normativity and its failure to adequately define well-being. Nevertheless, it can make a valuable contribution to an ethics of enhancement. As I will show, the welfarist account refocuses the debate on a central value in health care: well-being, which can be a relevant aspect in assessing the permissibility of biomedical interventions – especially against the background of new bioethical challenges. To fulfil this function, however, a more differentiated understanding of well-being is needed. (shrink)

The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin’s distinction between an “ethics of strangers” and an “ethics of intimacy”, can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an “ethics of intimacy”) and situations where HCP do not know their patients (corresponding to “an ethics of strangers”). Does it (...) make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by “knowing the patient”, we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics. (shrink)