For Victims of Fatal Child Abuse, Who Has the Right to Consent to Organ Donation?

In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.

[Bioethics theories, the protection of life and natural law]. / Teorías bioéticas, protección de la vida y ley natural.

Principlist Bioethics by Beauchamp and Childress has reached a prominent status in contemporary Bioethics. Nevertheless, it includes some important theoretical problems: some lacks when defining some concepts, a tendency to ethical relativism, etc. Among the ethical alternative approaches from which such problems can be solved, we think that the most appropiate is the Natural Law theory. It offers a reasoned reflection on the concept of good and on human basic goods and their relation with moral general principles. From such goods, this ethical theory supports the existence of actions that are always maleficent acts, that is, intrinsically and universally evil acts. The article applies the Natural Law theory to issues related to the protection of human life (abortion, euthanasia, self-defense and genetic manipulation)..

¿Existe el derecho a morir? / Is there a right to die?

El derecho a la muerte se define desde el olvido de la muerte, característica de la sociedad contemporánea. La defensa de la eutanasia, lejos de ser una contradicción con ese olvido, constituye su constatación. Afirmada como acto altruista y benevolente encubre la necesidad propia de olvidar el sufrimiento y la muerte, y la incapacidad de observar la muerte ajena. Como derecho, el derecho a la muerte se presenta como la prohibición del Derecho y la comunidad de interferir en el acto tanático para sí mismo o para otro. Pero como efecto se instaura un derecho de carácter social e indicación ética que constituye un riesgo para la vida dependiente

The right to death is defined from the oblivion of death, characteristic of contemporary society. The defense of euthanasia, far from being a contradiction with that forgetfulness, constitutes its verification. Affirmed as an altruistic and benevolent act conceals the need to forget suffering and death, and the inability to observe the death of others. As a right, the right to death is presented as the prohibition of the law and the community to interfere in the act of love for oneself or for another. But as an effect, a right of a social nature and ethical indication that constitutes a risk for dependent life is established

Abortion and deprivation: a reply to Marquis.

In 'Why Abortion is Immoral', Don Marquis argues that abortion is wrong for the same reason that murder is wrong, namely, that it deprives a human being of an FLO, a 'future like ours,' which is a future full of value and the experience of life. Marquis' argument rests on the assumption that the human being is somehow deprived by suffering an early death. I argue that Marquis' argument faces the 'Epicurean Challenge'. The concept of 'deprivation' requires that some discernible individual exists who can be deprived. But if death involves total annihilation, then no discernible individual exists to be so deprived. I argue that the Epicurean Challenge must be addressed before it can be proven that Marquis is correct to claim that abortion and murder are wrong because they deprive someone of an FLO.

How (not) to think of the 'dead-donor' rule.

Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don't Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don't Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics-unlike today's critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward.

La despenalización de la eutanasia en Colombia: contexto, bases y críticas / The decriminalisation of euthanasia in Colombia: context, foundations and critiques

En el debate global sobre la eutanasia el caso de Colombia, que la despenalizó en 1997, no suele ser discutido en profundidad. En este artículo se examinan el contexto socio-político y jurídico que permitió que la Corte Constitucional en 1997 a despenalizar el homicidio por piedad, los retos que implicó para la sociedad colombiana y los requisitos establecidos por esta corte en 2014 para hacer efectivo el derecho a la eutanasia. Al final se ofrecen algunas consideraciones críticas sobre el debate alrededor de la eutanasia en Colombia

In the global debate on euthanasia the case of Colombia, which decriminalised it in 1997, is barely discussed. In this article it is examined the socio-political and legal context in which the Constitutional Court decriminalised mercy killing in 1997, the challenges this decision meant for the Colombian society and the requirements this Court set in 2014 to guarantee the right to euthanasia. At the end, some critical considerations around the euthanasia debate in Colombia are offered

"The prohibition of euthanasia" and medical oaths of Hippocratic Stemma / "La prohibición de la eutanasia" y juramentos médicos de raíz hipocrática / "A proibição da eutanásia" e o juramento médico de Hippocratic stemma

It has been debated whether the Hippocratic Oath's commitment referring to not administering poisonous/ deadly drugs prohibits: euthanasia, assisted suicide or murder. The first goal was to analyze if the prohibition of administering poisonous/deadly drugs was kept and how it changed in medical oaths of Hippocratic stemma of different time periods and religious orientations. The second aim was discern what is forbidden: euthanasia, assisted suicide or murder. Seventeen medical oaths: 4 Medieval, 2 Modern and 11 Contemporary oaths were studied and divided into those expressing the commitment like the original, those that may include it depending on the interpretation and those that do not mention it. Medieval and Modern oaths express it similarly to the Hippocratic Oath, possibly due to religious and Hippocratic/Galenic influences. What they forbid cannot be inferred. Contemporary oaths maintaining the commitment tend to include phrases regarding active euthanasia and assisted suicide. Other contemporary oaths may generalize it. It would be advisable that medical oaths would contain clear and specific premises regarding this commitment depending on the country, school and the student body's idiosyncrasies.

Ha sido debatido qué es lo que prohíbe el compromiso del Juramento Hipocrático de no administrar drogas venenosas/mortales: la eutanasia, el suicidio asistido o el asesinato. El primer objetivo fue analizar si la prohibición de administrar drogas venenosas/mortales se mantuvo y cómo cambió en juramentos médicos de stemma hipocrática en diferentes tiempos y con distinta orientación religiosa. El segundo objetivo fue discernir qué se prohíbe: si la eutanasia, el suicidio asistido o el asesinato. Se analizaron 17 juramentos médicos: 4 medievales, 2 modernos y 11 contemporáneos. Se dividieron en aquellos que expresan el compromiso como el original, aquellos que podrían incluirlo o no dependiendo de la interpretación y aquellos que no mencionan nada al respecto. Los juramentos medievales y modernos expresan el compromiso de manera similar al Juramento Hipocrático, posiblemente por influencias religiosas e hipocrático/galénicas. Qué es lo que prohíben no puede ser inferido. Los juramentos contemporáneos que mantienen el compromiso suelen incluir frases en relación a la eutanasia activa y al suicidio asistido. Otros juramentos contemporáneos lo generalizarían. Sería recomendable que los juramentos incorporaran compromisos claros dependiendo de la idiosincrasia de los países, instituciones y cuerpo estudiantil.

Tem sido debatido se o compromisso do juramento de Hipócrates, referindo-se a não administrção de drogas venenosas/mortais, proíbe: a eutanásia, o suicídio assistido ou o assassinato. O primeiro objetivo foi analisar se a proibição de administrar drogas venenosas/mortais foi mantida e como isso mudou em juramentos médicos de Hippocratic stemma em diferentes períodos de tempo e orientações religiosas. O segundo objetivo foi discernir o que é proibido: eutanásia, suicídio assistido ou assassinato. Dezessete juramentos médicos: 4 medievais, 2 modernos e 11 juramentos contemporâneos foram estudados e divididos naqueles que expressavam o compromisso semelhante ao original, aqueles que podem incluir, consoante a interpretação e aqueles que não o mencionam. Os juramentos medievais e modernos expressam da mesma forma que o juramento de Hipócrates, possivelmente devido a influência religiosa e de Hipócrates/galênica. O que eles proíbem não podem ser inferido. Os juramentos contemporâneos, mantendo o compromisso tendem a incluir frases sobre eutanásia ativa e suicídio assistido. Outros juramentos contemporâneos podem generalizá-lo. Seria aconselhável que os juramentos médicos conteria premissas claras e específicas sobre este compromisso dependendo do país, a escola e as idiossincrasias do corpo estudantil.

Avoiding the Personhood Issue: Abortion, Identity, and Marquis's 'Future-Like-Ours' Argument.

One reason for the persistent appeal of Don Marquis' 'future like ours' argument (FLO) is that it seems to offer a way to approach the debate about the morality of abortion while sidestepping the difficult task of establishing whether the fetus is a person. This essay argues that in order to satisfactorily address both of the chief objections to FLO - the 'identity objection' and the 'contraception objection' - Marquis must take a controversial stand on what is most essential to being the kind of entity that an adult human being is. Such a stand amounts to a controversial account of personhood. To the extent that FLO's success depends on accepting such a controversial metaphysical view, one apparent attraction of FLO proves illusory.

Honor Killing: Where Pride Defeats Reason.

Honor killings are graceless and ferocious murders by chauvinists with an antediluvian mind. These are categorized separately because these killings are committed for the prime reason of satisfying the ego of the people whom the victim trusts and always looks up to for support and protection. It is for this sole reason that honor killings demand strict and stern punishment, not only for the person who committed the murder but also for any person who contributed or was party to the act. A positive change can occur with stricter legislation and changes in the ethos of the society we live in today.

Continuous deep sedation and homicide: an unsolved problem in law and professional morality.

When a severely suffering dying patient is deeply sedated, and this sedated condition is meant to continue until his death, the doctor involved often decides to abstain from artificially administering fluids. For this dual procedure almost all guidelines require that the patient should not have a life expectancy beyond a stipulated maximum of days (4-14). The reason obviously is that in case of a longer life-expectancy the patient may die from dehydration rather than from his lethal illness. But no guideline tells us how we should describe the dual procedure in case of a longer life-expectancy. Many arguments have been advanced why we should not consider it to be a form of homicide, that is, ending the life of the patient (with or without his request). I argue that none of these arguments, taken separately or jointly, is persuasive. When a commission, even one that is not itself life-shortening, foreseeably renders a person unable to undo the life-shortening effects of another, simultaneous omission, the commission and the omission together should be acknowledged to kill her. I discuss the legal and ethical implications of this conclusion.

Culture in the Courtroom: Ethnocentrism and Juror Decision-Making.

The purpose of this study was to investigate whether a culturally-based argument in a non-insane automatism defense would be detrimental or beneficial to the defendant. We also examined how juror ethnocentrism might affect perceptions of such a defense. Participants read a fictional filicide homicide case in which the defendant claimed to have blacked out during the crime; we manipulated whether culture was used as an explanation for what precipitated the defendant's blackout. We conducted path analyses to assess the role of ethnocentrism in predicting lower defendant credibility, and harsher verdict decisions. Results revealed an interaction between ethnocentrism and defense type, such that ethnocentrism related to lower perceived defendant credibility in the cultural condition, but not in the standard automatism condition. This study marks a starting point for empirically investigating the role of culture in the courtroom, which may aid scholars in discussing the merits of a standalone cultural defense.

Broadening the future of value account of the wrongness of killing.

On Don Marquis's future of value account of the wrongness of killing, 'what makes it wrong to kill those individuals we all believe it is wrong to kill, is that killing them deprives them of their future of value'. Marquis has recently argued for a narrow interpretation of his future of value account of the wrongness of killing and against the broad interpretation that I had put forward in response to Carson Strong. In this article I argue that the narrow view is problematic because it violates some basic principles of equality and because it allows for some of the very killing that Marquis sets out to condemn; further, I argue that the chief reason why Marquis chooses the narrow view over the broad view-namely that the broad view would take the killing of some non-human animals to be also wrong-should rather be considered a welcome upshot of the broad view.

Why religion deserves a place in secular medicine.

As a science and practice transcending metaphysical and ethical disagreements, 'secular' medicine should not exist. 'Secularity' should be understood in an Augustinian sense, not a secularist one: not as a space that is universally rational because it is religion-free, but as a forum for the negotiation of rival reasonings. Religion deserves a place here, because it is not simply or uniquely irrational. However, in assuming his rightful place, the religious believer commits himself to eschewing sheer appeals to religious authorities, and to adopting reasonable means of persuasion. This can come quite naturally. For example, Christianity (theo)logically obliges liberal manners in negotiating ethical controversies in medicine. It also offers reasoned views of human being and ethics that bear upon medicine and are not universally held-for example, a humanist view of human dignity, the bounding of individual autonomy by social obligation, and a special concern for the weak.

'Total disability' and the wrongness of killing.

Walter Sinnott-Armstrong and Franklin G Miller recently argued that the wrongness of killing is best explained by the harm that comes to the victim, and that 'total disability' best explains the nature of this harm. Hence, killing patients who are already totally disabled is not wrong. I maintain that their notion of total disability is ambiguous and that they beg the question with respect to whether there are abilities left over that remain relevant for the goods of personhood and human worth. If these goods remain, then something more is lost in death than in 'total disability,' and their explanation of what makes killing wrong comes up short. But if total disability is equivalent with death, then their argument is an interesting one.

[Spurious pity--lethal consequences: how helpers turn into offenders]. / Falsches Mitleid - tödliche Konsequenzen: Wie aus Helfern Täter werden.

This study gives a general view of 40 cases of killing series by members of staff in health care professions in hospitals and homes. The main issue of the analyses are the nine killing series in the German language area. For the investigation legal documents concerning specific characteristics of victims, site of crime and offenders were evaluated. The respective fields of work were investigated concerning the working climate, the position of the offenders in their working group, conflicts in the work place and the handling of the first intern hints to suspective behaviour. It is derives from the case-by-case analyses if there are any preliminary warnings and if there are any commonalities with regard to the victims, the offenders and the respective fields of activity. Personal sensitivities, working conditions and permanent confrontation with human sufferings can be interlaced with each other in that way that the superficial motivation to help is abysmally reversed. In this repect a term of compassion, which confounds real sympathy and self-pity, is essential.