This article explicates two approaches to the basis of moral worth and status: Eva Kittay’s relational view and Jeff McMahan’s psychological personhood view. It is argued that these theories alone do not provide adequate support for the conclusions Kittay and McMahan want to draw concerning individuals whose entitlement to fundamental protections can be challenged—infants with severe cognitive disabilities and infants without the support of their families and social environments. The real justification can in each case be found in deeply held convictions regarding entities that must and entities that must not be included in the core community of moral equals. Philosophical discussions about these convictions would be more useful for the advancement of our moral thinking than vain attempts to show that the absolute truth lies on either side of the ongoing debate.

The tension between the use of postcolonial memory to bear witness to the past and the aestheticization of memory lies at the center of Malaysian-born writer Tan Twan Eng’s second novel, The Garden of Evening Mists (2012), a work that features the Japanese occupation of Malaya during World War II and the postwar period of the Malayan Emergency. The main protagonist is a former judge named Yun Ling who, faced with the prospect of eventual memory and speech loss, is moved to record her past experiences including the time she was a prisoner of war interred and when she was an apprentice to the gardener, Aritomo. In this article, I examine the novel’s self-conscious musings about the nature of memory and the ways in which memory may be represented and preserved. Tan’s novel attempts to provide a meditation on the transcultural mediation and aestheticization of memory by deliberately intermingling and overlaying various cultural features, artistic traditions and ethno-cultural subjectivities when it comes to processes of remembering. The attempt to transculturally aestheticize memory is on one level a metafictional and ostensibly inclusive move to affirm the plurality of stories and multiple perspectives. Yet, this is undermined by the novel’s very strategies of aestheticization, which run the risk of making memory an artistic object so “precious” and rarefied as to counter the more avowedly political function of memory—that of bearing witness to history.

One of the widely recognized facts about human dignity is its vastly divergent applicability—from highly controversial issues in bioethics to broader topics in political philosophy. A group of theories that this article subsumes under the header “natural good theories” appears to be especially fitted for normatively multifaceted notions like dignity. However, the heavy normative weight the concept of dignity has to bear due to the central position it occupies within these theories creates its own difficulties. As is shown in a discussion of Martha Nussbaum’s capability conception of dignity, dignity appears to be unable to mirror the special normative relevance people want to assign to it in cases of great moral misconduct. The article provides a suggestion on how to solve this problem by means of paradigmatic cases that work as material constraints regarding the exact boundaries of dignity violations.

An individual’s hesitance or outright refusal to function as a substitute decisionmaker creates a number of challenges for treating teams, as is highlighted by the case of KS. It is not uncommon for individuals who suddenly find themselves in the role of substitute decisionmaker (SDM) to experience feelings of inadequacy or of being overwhelmed. The natural apprehension that comes with realizing, or being informed, that you are now responsible for providing or refusing consent on behalf of a loved one is often exacerbated by the accompanying circumstances. Even though there are movements afoot to encourage and support advance care planning and the inclusion of those who will become SDMs in conversations about values and wishes, there is still much work to be done. Although the case as presented does not provide information regarding what, if any, processes have taken place prior to the current hospital admission with regard to including the patient’s sister in discussions about future circumstances, it is clear that the sister feels unprepared to assume the role being thrust upon her. What, then, does a clinical ethics consultation have to offer in such situations? The following discussion highlights three ways in which ethics consultation can be of value to both the treating team and the identified SDM: ethics consultation (1) helps the care team and SDM navigate the regulatory landscape, (2) supports the treating team, and (3) supports the SDM.

This case illustrates the dilemma that occurs when a patient refuses treatment. When a patient refuses recommended interventions, it can cause much distress among the medical team and family. On the surface, the ethical issue appears to be in regard to treatment refusal. However, when we look deeper, it becomes evident that the question is truly about whether the patient has the ability to make this treatment decision, given her worsening dementia, recent hemorrhage, and depression. In this case, an essential component of an ethics consultation would be to assess this patient’s decisionmaking capacity to determine if her refusals are informed. This case has another level of complexity. If the patient does not have decisionmaking capacity, then who would be willing to serve in the role of surrogate decisionmaker? The case raises several ethical questions and thus makes directing a patient’s care and decisionmaking challenging.

In this article, we discuss the ideas of Eric J. Cassell about the patient-professional relationship. We argue that his approach combines in an interesting way features from the literature on patient autonomy and paternalistic practices. We suggest that these seemingly paternalistic features of practicing medicine, which are widely either ignored or condemned in bioethical discussion, are of vital significance in medical practice. In the first sections of the article, we describe the main features of Cassell’s understanding of the sick person and his version of personalized medicine. We pay particular attention to his notion of information control and compare his ideas about conversation with patients to Hans-Georg Gadamer’s analysis of patient-professional dialogue. In the latter part of the article, we explore through a couple of examples the implications these ideas have for medical practice.

Something strange has happened to the concept of dignity in bioethics. After a long period in which U.S. pragmatist and U.K. consequentialist philosophers have argued that the concept is useless and vacuous, and in which they have been reasonably successful in expunging it from mainstream English-language academic bioethics, dignity has suddenly become popular again in debates about the legalization of physician-assisted dying (PAD). And, even stranger, it is deployed not by conservatives but by liberals. In the debates about PAD, liberal proponents of legalization seem to accept without question that there is such a state or process as “death with dignity,” which is juxtaposed to “undignified dying.” It also seems to be accepted that both of these states can be fairly easily identified and that they carry great moral weight. This article provides an analysis of the current resurgence of “undignified” arguments and argues on the basis of that analysis (1) that a proper understanding of the concept of dignity shows that the previous reductive arguments against dignity are partially incomplete and therefore partially misguided and (2) that, despite dignity having meaning, the idea of an undignified death cannot carry the moral weight it is given by proponents of the legalization of PAD.

KS is a 76-year-old Burmese woman who presented to the hospital with right-sided weakness that had begun two days prior. Although KS had been diagnosed earlier with dementia and had a medical history of stroke, she was living at a nursing home and was able to walk on her own and use her right arm to feed herself. Since her last stroke three years ago, she had also developed aphasia, and her speech has been minimal. During her current hospitalization, KS was found to have a cerebral hemorrhage, but after consultation with neurosurgery, the team determined that no medical interventions were available, and a higher level of care was not required. She also presented with other medical conditions, including severe hypertension, chronic kidney disease, and depression. The patient’s blood pressure has remained high. She has now failed a swallow evaluation and is refusing the insertion of a nasogastric feeding tube. The patient has a younger sister who believes, from a cultural perspective, that only the patient should make her medical decisions. As a result, she feels helpless in assisting the team. The medical team has asked for an ethics consultation to direct the patient’s care and to guide decisionmaking.

In bioethics, the concept of vulnerability is applied almost exclusively to research participants and patients. We turn the tables and apply the concept to nurses caring for anorexia nervosa (AN) sufferers. In doing so, and using results from a qualitative research study undertaken in the UK, we show that AN nurses face a significant probability of incurring identifiable harms (inauthentic relationships and nonreciprocal relationships). Some recommendations on how these harms can be avoided or mitigated are given, but further research is needed.

Sometime in early 1434, two northern Italian counts, Francesco Pico della Mirandola and his brother Giovanni, sent a letter to Pope Eugene IV (r. 1431–47). Out of concern for their subjects, who had long suffered from a shortage of credit, Francesco and Giovanni had allowed some Jews to settle in their lands and lend at interest. In addition, the brothers had rented a house to these Jews for the purpose of moneylending. At the time, the noblemen stressed, they had not believed their actions to be unlawful. They had since come to fear, however, that they had inadvertently brought automatic excommunication upon themselves by violating the provisions of Usurarum voraginem, a decree first issued at the Second Council of Lyon in 1274 that called on secular and religious authorities to refuse lodging to foreign usurers and, in addition, to expel such usurers from their lands. The brothers' uncertainty, the petition noted, reflected the varied opinions of contemporary jurists (presumably those at Bologna, a mere 60 kilometers away), who disagreed on whether the decree was to be understood in reference to Jewish as well as Christian moneylenders. Deciding to err on the side of caution, the brothers petitioned the Holy Father to grant them absolution, if they had indeed incurred ecclesiastical censure through their actions. In addition, they asked to be granted a dispensation allowing the Jews to remain in their lands, so as to spare their subjects from even greater economic misfortune.

Thomas King’s novel Green Grass, Running Water stands as an indictment of North American colonialism and the continuing injustices facing indigenous peoples; it also offers valuable insights in terms of what constitutes good teaching. With reference to personal experiences of teaching the novel in a large lecture course, this article discusses its author’s efforts at implementing the novel’s implied pedagogical principles, which include a scepticism about granting authority to certain texts over others; a collaborative model of learning; a wariness regarding totalizing narratives and claims of interpretive mastery; and a need to wrestle in class discussion with texts’ unresolved problematics.