Thesis (DPhil)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: In this dissertation, I grapple with the problem of global drug resistance and moral responsibility which, as far as I am aware, has so far not been presented as a topic of ethical inquiry. It represents a conundrum involving three major factors: microbial adaptation and change, human social factors and environmental changes. Drug resistance is a phenomenon in which certain microorganisms, when exposed to antimicrobial agents, may acquire the beneficial trait of drug resistance which ensures a better potential for their survival. The acquired trait of drug resistance I argue renders such microorganisms 'supra-natural '. Supra-natural is a term I coin for entities that have been imposed upon nature by human design; they do not follow the natural evolutionary processes of adaptation and change. Drug resistance is classified as an emerging infectious disease. Human social factors and environmental change (particularly population growth, density and consumerist practices) enhance the rise of emerging infectious diseases. Through such increasing destructive practices, stress is placed on the environment. Environmental stress facilitates the rise of new and old infectious diseases and the spread of drug resistant supra-natural microorganisms. Thus, our ability to treat successfully illnesses and injuries in humans, animals and plants is increasingly impaired. Morally, we are responsible for the problem of global drug resistance. Drug resistant microorganisms exist in nature and concerning this, we can do nothing. At best, we can only try to control the problem using prudential measures. The problem of global drug resistance represents both a biomedical ethical and an environmental ethical issue. Is there a way out of the human-nature debate? Through Bryan Norton's enlightened anthropocentrism, I identify the ways in which his thesis may be applied to the problem of human and environmental concerns and show its applicability in broadening the parameters of biomedical ethics education to include environmental concerns. / AFRIKAANSE OPSOMMING: In hierdie proefskrif bespreek ek die probleem van die verskynsel dat mikroorganismes op 'n globale skaal weerstand begin bied teen mediese middels (globale middel-weerstandigheid) en die morele verantwoordelikheid wat dit oproep - 'n probleem wat, na my beste wete, nog nooit aangebied is as 'n tema van etiesfilosofiese ondersoek nie. Dit verteenwoordig 'n kompleks van drie belangrike oorwegings: mikrobiese aanpassings en veranderinge, menslike sosiale faktore, en omgewingsveranderinge. Middel-weerstandigheid is 'n verskynsel waarin sekere mikro-organismes, wanneer hulle blootgestel word aan antimikrobiese agente, die (vir hulself) voordelige kenmerk kan bekom van weerstandigheid teen die middel; iets wat 'n beter potensiaal vir hul eie oorlewing verseker. Hierdie bekomde kenmerk (middel-weerstandigheid) maak, volgens my argument, sulke mikro-organismes 'supra-natuurlik'. Supra-natuurlik is 'n term wat ek munt vir entiteite wat aan die natuur blootgestel is as gevolg van menslike ontwerp; hulle volg nie die natuurlike evolusionêre prosesse van adaptasie en verandering nie. Middel-weerstandigheid word geklassifiseer as 'n opkomende aansteeklike siekte. Menslike sosiale faktore en omgewingsveranderinge (veral bevolkingsgroei, -digtheid and verbruikerspraktyke ) vergroot die opkoms van aansteeklike siektes. Deur sodanige toenemende destruktiewe praktyke word stres geplaas op die omgewing. Omgewingstres fasiliteer die opkoms van nuwe en ou aansteeklike siektes asook die verspreiding van weerstandige supra-natuurlike mikro-organismes. Ons vermoë om siektes en beserings van mense suksesvol te behandel, word gevolglik toenemend ondermyn. Moreel gesproke is ons verantwoordelik vir die probleem van globale middelweerstandigheid. Middel-weerstandige mikro-organismes bestaan in die natuur, en aan daardie feit as sodanig kan ons niks doen nie. Ons kan, ten beste, probeer om die probleem te beheer deur middel van verstandige maatreëls. Die probleem van globale middel-weerstandigheid verteenwoordig sowel 'n biomedies-etiese as 'n omgewingsetiese kwessie. Is daar 'n uitweg uit die mens-natuur debat? Ek identifiseer, met 'n beroep op Bryan Norton se swak antroposentrisme, maniere waarop sy tese toegepas sou kon word op die probleem van menslike en omgewingsoorgwegings Ek wys ook op die toepaslikheid daarvan vir die verbreding van die parameters van biomediese etiek-opvoeding ten einde omgewingsoorwegings deel van 19.te maak.

This dissertation contributes to the philosophy of empathy and biomedical ethics by drawing on phenomenological approaches to empathy, intersubjectivity, and affectivity in order to contest the primacy of the intersubjective aspect of empathy at the cost of its affective aspect. Both aspects need to be explained in order for empathy to be accurately understood in philosophical works, as well as practically useful for patient care in biomedical ethics. In the first chapter, I examine the current state of clinical empathy in medicine including professional opinions about empathy, the dominant definition being employed, and the problems that arise from this definition. By trying to define empathy in a way that is useful to the current presuppositions in medicine, clinical empathy aligns with simulation theory, which has three problems: the discrepancy between the way empathy is defined and the way it is explained, the lack of diversity that this theory of empathy allows in our understanding of others, and the lack of affective understanding and affective engagement involved in the patient-physician interaction. These three problems are used to derive three questions that are important for any theory of empathy: (1) What is the phenomenon being explained? (2) What is the intersubjective context of empathy? (3) What is the affective dimension of empathy? The best theory of clinical empathy can be formulated by answering these three questions as they relate to phenomenological theories, which are more attuned to overcoming presuppositions. Chapters two and three each examine a different phenomenological approach to empathy from opposite extremes in their theories of intersubjectivity. Husserl and Stein begin from an isolated, transcendental subject that needs empathy to bridge the gap between itself and others, while Scheler begins from a primary intersubjectivity in which self and other are undifferentiated, making empathy a largely unnecessary skill. Despite their strongly opposed positions, and the acknowledgement that their theories of intersubjectivity necessitate their theories of empathy, I argue that both fail to understand the affective dimension of empathy. Husserl and Stein leave no room in empathy for it to be an affect, while Scheler prioritizes affects that reunite subjects, but leaves empathy itself as a non-affective skill. Chapter four explains Gallagher’s interaction theory as a more moderate approach to the relation between empathy and intersubjectivity. He draws on the insights of the other two theories, but conceives of empathy as a multi-leveled phenomenon that allows for an understanding of others. While this theory does aid in addressing the intersubjective context of empathy in a way that best solves the first two problems with clinical empathy, interaction theory still fails to fully address the affectivity of empathy, maintaining empathy as a largely cognitive ability. Gallagher does acknowledge the affective core of empathy, but he does not explain the way in which it is affective. In response to this problem, I explain Anya Daly’s application of Merleau-Ponty’s theory of reversibility to affectivity as a possible solution to the problematic gap in Gallagher’s theory. Chapter five focuses on theories of clinical empathy in order to address the neglected affective aspects of empathy, and respond to the problem of detached concern. The problems caused by detached concern are explained, as well as why the theories discussed in the middle chapters are still unable to solve them. This is done in two parts. In the first part, I explain the basis of this issue in the cognitive/feeling divide, as explained in the philosophy of emotion. Then, I give a brief overview of the phenomenology of affectivity to be used as a guide to the affectivity of empathy. In the second part, I examine three theories of clinical empathy that attempt to solve the problem of detached concern, noting their strengths and weaknesses based on their similarities to phenomenological approaches to empathy and affectivity.

Introduction Attention deficit hyperactivity syndrome (ADHD) is a neuropsychiatric disorder that is characterized by three core symptoms: inattention, hyperactivity, and impulsivity. The prevalence of ADHD is estimated to be 3-10 %. The number of ADHD diagnosis and prescriptions of central stimulants that are used to treat the disorder have been steadily growing which has led to debates about the diagnostic process and pharmacological treatment. The ethics of the diagnostic process and treatment have been discussed, and it has been pointed out that there’s a lack of knowledge about how the ADHD patients experience the diagnosis and treatment. Aim The aim of this study is to review the existing knowledge of the ADHD patient experiences concerning the diagnosis and the medical treatment, and to examine this knowledge in the light of medical ethics. Method This is a scoping review. Eight studies were included in this study. The inclusion criteria were that the participants of the studies were interviewed by using semi-structured interviews, both genders were included, and that the interviews covered both diagnosis and medical treatment. Material was analysed by using qualitative content analysis. Results Four main themes emerged from the material: access, diagnosis, treatment, and impairment. All the main themes include several sub-categories. Conclusion In the light of the principles of biomedical ethics the diagnostic process and the treatment measures of ADHD are not ethically trouble-free. Studying the patient experiences does evoke ethical question of patients’ autonomy and the justification of distribution of needed services.

Ectogenesis has been billed a revolutionary new advancement in technology that could have a profound impact in the area of human reproduction. My aim is to investigate the supposed benefits and objections to the development of human ectogenesis with a particular focus on potential consequences on the abortion debate and reproductive equality between men and women. I will conclude that arguments for human ectogenesis are not well supported and there fails to be a strong motivation to develop it further, other than as advancement to the area of providing better neonatal care for premature babies.

Within the Folds is a 70,000 word novel where prehistory and the near future meet together in a narrative examining the forces of evolution and duration. The work particularly focuses on the conceptual changes taking place in parenting models as biomedical science gives opportunities to reproductive paradigms which were previously impossible. Taking the premise that developments in human engineering are unstoppable, I explore the transgenic boundaries between 'natural evolution' and proactive human design, conceptually and thematically, as new models of gender roles within family life become inevitable.

Human cultures have used classic psychedelics for healing purposes for millennia, emphasizing their subjective effects. In the 21st century, research has been revived to investigate the therapeutic effects of these substances. These substances show promising results in the treatment of various mental-related disorders such as depression, post-traumatic stress disorder, and others, necessitating ethical considerations and guidelines for researchers, psychotherapists, and policymakers. The subjective effects of the psychedelic experience that these substances evoke, such as the feeling of oneness and interconnectedness, infallibility, the sense of reduced one's self-importance, the encounter with the "ultimate" reality or with God, radically distinguish them from typical psychiatric medications such as selective serotonin reuptake inhibitors (SSRIs). In their essay "Ethics and Ego Dissolution: the Case of Psilocybin", William R. Smith and Dominic Sisti argue that the special properties of psychedelics entail certain novel risks that warrant "enhanced" informed consent that is "one that is more comprehensive than what may be typical for other psychiatric medications". They emphasize the unique effects of these substances, including 1) the potential for significant personality changes, 2) the short duration of treatment, and 3) the potential for profound and transformative experiences. They highlight the importance of explicitly addressing these potential changes as part of the informed consent process to ensure patient understanding, autonomy, and well-being. This current paper substantially complements Smith and Sisti's work by discussing in more detail the differences between psychedelics and typical psychiatric medications with respect to informed consent. I first support their arguments and then further argue that there are three other critical reasons why psychedelics should not be treated like other psychiatric medications that should be considered when discussing the enhancement of informed consent and disclosure. 1) potential changes in ethical values, 2) set and setting, and 3) suggestibility. To clarify my argument, I propose a distinction between changes in worldview and ethical values induced by the psychedelic experience and emphasize their differential impact on individuals undergoing psychedelic therapy. I introduce the term "ethical limbo", characterized as a state of uncertainty or ambiguity regarding the ethical implications or consequences of a particular action, decision, or situation due to conflicting ethical values, to highlight a potential risk of the psychedelic experience that should be considered in informed consent. Finally, I address potential objections to my arguments before concluding the paper and addressing some limitations of the research.

This study examines how the concepts of biomedical ethics are considered in Islam and how historical Islamic medical scholars treated the concept of ethics in their practice of medicine. Moreover, this research explores the principle of autonomy in biomedical ethics as a factor in Islamic practice of medicine. The issue of autonomy in medical practice is an important topic of discussion requiring examination of the methods of its adaptation and application in Muslim-majority countries. The value and significance of this topic continues at a global level, involving Muslim communities in Non-Muslim countries experiencing religious and social diversity. The fieldwork of this study was conducted in Turkey, Jordan and Gaza Strip, Palestine, investigating the subject matter with practitioners in health care sectors as well as with leading academics, researchers, non-government organizations and policymakers. The results indicate that the principle of autonomy is not fully implemented in the three countries from an Islamic perspective. / 博士(グローバル社会研究) / Doctor of Philosophy in Global Society Studies / 同志社大学 / Doshisha University

Thesis (MPhil)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Introduction From the postmodern ethical perspective [the postmodernist would say Jrom the ethical perspective], there is something suspicious and inherently unethical in a system of ethics supported by a comprehensive, cohesive and universal metanarrative, a set of fixed and unbending ethical rules and laws, without the ready possibility of revision [Cilliers, 1998, pp.114, 137-140; Cilliers, 2001, p. 3; Cilliers, 1995, p.125]. Based on the ideas of especially Winkler [1993, pp. 343-365] I have concluded that contemporary mainstream biomedical ethics, represented and directed by the work of Beauchamp and Childress [1994] are caught in such a crush. The primary objective of this assignment is to evaluate the 'principles' of biomedical ethics [respect Jar autonomy, beneficence, non-maleficence and justice] which were developed in their water-shed publication [Principles of Biomedical Ethics, Oxford University Press, first published in 1979, and now in a fifth edition, 2002] against a background of postmodern ethics. Methodology and conclusions I have argued that Beauchamp and Childress' conception of principlism is a contextual legalistic-philosophical response to the contemporary American situation, developed primarily from legal decisions [often litigation]. It may be regarded as acceptable practice guidelines, but represents a system of ethics without morality. I have given a concise rendering of Winkler's notion of context-based bioethics with the criticism that this also does not guarantee morality. Following that, there is a description of postmodern society in terms of complexity theory. I have indicated how the characteristics of complexity can be developed and applied contextually in bioethics. The postmodern moral society is the locus where morality develops in a non-controllable agonistic interactive process within which the postmodern moral agent unintentionally finds himself. The postmodern ethical position is not an unethical, come-as-you-may anything-goes position; it simply is not predictable, controllable, universal, rational [in a Kantian context] and eternal. Modernity, it can be argued exhibits a far greater degree of relativism. The postmodern ethical position represents a return to morality in ethics, morality of a very personal, face-to-face responsibility from which we as participants of society cannot hide. From a postmodern ethical perspective, an analysis of principlism and its underlying principles exhibits the characteristics of modernity: eternal moral rules which as such cannot be presented as morality. I have acknowleged Beauchamp and Childress' attempts at adding morality to their conception [in the 4th edition] by means of employing character ethics. They have nevertheless not made any radical changes in the format of their presentation and maintain the central and primary role of principles. I have also argued the limitations of the postmodern approach in terms of enclaves of strictly controlled modernity and artificial witholding of information in medicine which limit the free flow of information essential to the postmodern approach. My conception of complexity and the postmodern approach do not pretend to be a panacea for biomedical ethics. It attempts to redefine the meaning of morality in bioethics and questions the unbridled application of this conception of principIism. Finally I have discussed the burning issue of justice in the practice of medicine from the postmodern perspective. Do I as a person have a right to health care; what are the moral issues of dealing with 'life's lotteries'; what is the state's responsibility in health care, and: what are my personal responsibilities in health care? In contradistinction to libertarian concepts, the postmodern approach clearly argues in favour of the acceptance by the state of its role in health care [a responsibility abrogated in many societies, none more so than contemporary South-African society]. / AFRIKAANSE OPSOMMING: Inleiding Daar IS uit die perspektief van die postmoderne etiese standpunt [die postmodernis sou sê, uit die etiese perspektiej], iets verdags, iets inherent oneties aan 'n sisteem van etiek wat 'n enkele goed omskrewe, kohese en omvattende universele metanarratief voorhou, 'n stel vaste en onbuigsame etiese reëls en wette voorskryf en afdwing sonder om konteks en gevolge te oorweeg, en sonder die geredelike moontlikheid van revisie [Cilliers, 1998, pp.114, 137-140; Cilliers, 2001, p. 3; Cilliers, 1995, p.125]. Dit is, n.a.v. die denke van veral Winkler [1993, pp. 343-365] my oortuiging dat die hoofstroom-denke in biomediese etiek in so 'n drukgang vasgevang is, en verteenwoordig word en gerig is deur die denke van Beauchamp en Childress [1994]. Hierdie werkstuk gaan in hoofsaak daarom om Beauchamp en Childress se toepassing van die beginsels van biomediese etiek soos sedert 1979 in hul waterskeidingsboek 'Principles of Biomedical Ethics' [Vierde uitgawe, Oxford University Press, 1994; daar is nou ook 'n vyfde, 2002] uiteengesit, ontwikkel, bespreek en gepropageer [respek vir outonomie, weldadigheid, non-kwaadwilligheid en geregtigheid] teen die agtergrond van 'n postmoderne etiese beskouing te evalueer. Metodologie en gevolgtrekkings Ek het in hierdie werkstuk aangetoon dat Beauchamp en Childress se weergawe van prinsiplisme 'n kontekstuele wetlik-filosofiese reaksie op die kontemporêre Amerikaanse situasie is, hoofsaaklik uit regsaksie [dikwels litigasie] voortvloei, as goeie praktyksriglyne beredeneer kan word maar etiek sonder moraliteit verteenwoordig. Ek het 'n kort uiteensetting van Winkler se weergawe van 'n konteks-gebaseerde benadering gegee, maar aangetoon dat ook dit nie moraliteit waarborg nie. Daarop het ek 'n beskrywing van die postmoderne samelewing n.a.v. kompleksiteitsteorie gegee, en aangetoon hoe die eienskappe van kompleksiteit kontekstueelontwikkel kan word om in bioetiek toegepas te word. Die postmoderne gepostuleerde morele gemeenskap is die lokus waar moraliteit ontstaan deur 'n onbeheerbare agonistiese proses van interaktiewe wisselwerking waarby die postmoderne morele agent homself onwillekeurig betrokke vind. Die postmoderne etiese posisie is nie onetiese, lukraak, doen-soos-jy-wil relativisme nie; dit is bloot nie 'n voorspelbare, ewige, beheerbare, universele en [Kantiaans-] rasionele sisteem nie; moderniteit is [was?] in effek veel meer relativisties. Die postmoderne etiese standpunt verteenwoordig in my interpretasie 'n terugkeer tot moraliteit in etiek, moraliteit van 'n persoonlike, ingrypende, verantwoordelike aangesigtot- aangesig aard waaraan ons nie kan ontkom nie. Vanuit 'n postmoderne etiese perspektief het ek 'n analise van prinsiplisme en die individuele beginsels gemaak, en aangetoon dat hulle die eienskappe van die 'ewige morele reëls' van moderniteit openbaar en nie sonder meer as morele beredenering voorgehou kan word nie. Ek het erkenning gegee aan Beauchamp en Childress se eie pogings om dit te besweer deur karakteretiek as 'n essensiële tot hul formule toe te voeg, maar die kritiek uitgespreek dat hulle desnieteenstaande hierdie belangrike erkenning, nie bereid is om die formaat van hul aanbieding [ook in die jongste vyfde uitgawe, 2002] radikaal te wysig nie. Hulle oorbeklemtoon die beginsels steeds as sentraal en primêr. Terselfdertyd het ek die beperkings van die postmoderne benadering uitgelig, veral in terme van enklawes van streng-beheerde moderniteit in geneeskunde en 'n kunsmatige weerhouding van die vrye vloei van informasie wat kompleksiteit en die postmoderne situasie kenmerk. My konsepsie hou nie kompleksiteit en 'n postmoderne benadering voor as 'n panakeia vir biomediese etiek nie; dit dien eerder om die betekenis van moraliteit in bioetiek te herdefinieer en die kontemporêre algemene en ongekwalifseerde toepassing van hierdie weergawe van prinsiplisme te bevraagteken. Laastens het ek die brandende vraag van geregtigheid in die praktyk van geneeskunde vanuit 'n postmoderne perspektief bespreek, veral of ek as persoon kan aanspraak maak op 'n reg tot gesondheidsorg, die morele implikasies van 'life's lotteries', die staat se verantwoordelikheid in gesondheidsorg en les bes, persoonlike verantwoordelikheid in gesondheidsorg. Dit is duidelik dat 'n postmoderne benadering tot bioetiek, in teenstelling met libertêre konsepsies, die staat se rol in gesondheidsorg onderskryf ['n rol wat die staat byna universeel, en veral in Suid-Afrika, verwaarloos].

Thesis (MPhil (Philosophy))--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Every individual has a mental image of what a ‘good’ life entails. Whether this idea of a good life is based on hedonist, preference satisfaction or ideal theories, or a combination of these theories, it forms the underlying framework that indicates and measures how well or how poorly we are doing. The smaller the discrepancy between these suppositions we nurture and our real circumstances, the greater the degree of wellbeing and satisfaction we experience. This satisfaction with our lives can be indicated on objective and subjective scales, and these serve as a direct reflection of our quality of life. In addition to self experienced quality of life, quality of life is also seen as the aim of health care. However, as the World Health Organization (WHO) sketches an almost utopian view of health, the field is deemed to be so wide that it includes man in his totality. This state of total psychological, physical and social welfare is further seen as a primary or basic necessity to which everyone is entitled. Human welfare, or quality of life, viewed from a healthcare perspective, serves as the criterion for substantiating, informing and guiding health care. Not only are choices regarding the type and degree of intervention in the therapeutic situation guided by this, but quality of life is also regarded as the single cut-off point for determining whether continued existence would be better or worse than not existing at all. A further outcome of quality of life is the use of QALYs (quality-adjusted life years) and TTO (Time trade-off). These instruments are designed to determine the net efficiency of therapeutic intervention by combining two dimensions, namely quality and quantity of life. Quality of life and [healthy] lifespan are therefore combined in a single framework of value assessment, and this framework is applied as the main criterion for allocating limited resources. This application of quality of life has been adjusted to serve as the main measure for determining the value of a life. In this study quality of life will critically be investigated with the focus on self experienced quality of life; quality of life as the aim of health care; and quality of life as the determining factor to place a value on a human life. The study indicates that the concept of quality of life had to undergo a natural and unavoidable development and expansion to keep pace with the changed medical ethos of our times. The writer indicates that the transformation of quality of life as the aim of healthcare to quality of life as the factor for determining the value of a life is currently ethically unacceptable in its application. Finally, a more acceptable development that includes referred competition and social responsibility is suggested.

在高度醫療化的現代社會當中，醫病關係是一個不容忽視的重要議題。二十世紀的醫療科技突飛猛進，但是病患所接受的醫療品質卻是越來越低劣。醫生過度強調科學與理性，失去對病人的尊重，因而導致醫療系統凌駕於人性之上的情境。《哈維》與《心靈病房》分別描述了病患在醫院所經歷的治療過程。透過這兩齣戲的比較，本文發現二十世紀下半葉的醫療系統對待病患的態度並無改善。透過傅柯與生命倫理學的觀點，本文旨在說明二十世紀醫療系統對人性所造成的迫害，並且探討醫療體系的威權如何被建立以及病患的自主權如何被剝奪。 　　本論文分為四章。第一章說明柴絲和愛德森的生平背景、《哈維》與《心靈病房》的相關評論以及本論文的理論架構。第二章透過傅柯的觀點闡述醫護人員無形中施加於病患身上的醫療暴力。第三章透過生命倫理學的角度分析病患任由醫療體系擺佈的過程。第四章總結醫護人員對病患的操控以及病患在醫療系統中所遭遇的困境，並且重申醫療系統應該以「以病患為中心」的醫療模式取代傳統霸權式的醫療。 / In the madicalized society, the doctor-patient relationship is a significant issue because medical science has had tremendous breakthroughs in the twentieth century, yet the quality of hospital care has become worse. Doctors, over-relying on science and rationality, lose respect for their patients, which leads to a situation of medical apparatuses above humanity. Mary Chase’s Harvey and Margaret Edson’s Wit describe patients’ experience in hospital respectively. Through the comparison and contrast of the plays, this thesis cannot see any improvement in doctors’ treatment of patients. Therefore, aiming at demonstrating the dehumanizing evil of medical apparatuses, this thesis elaborates the construction of medical authority from the perspective of Foucault’s analysis of disciplinary power and reflects on the deprival of patients’ autonomy with the approach of biomedical ethics. This thesis is divided into four chapters. Chapter One introduces the backgrounds of the authors, literature review of Harvey and Wit and the theoretical frameworks of Foucault and biomedical ethics. Chapter Two, focusing on the rigid disciplinary power of medical apparatuses, illustrates hospital staff’s evil practice on patients. Chapter Three demonstrates the dehumanized patients under the manipulation of medical discipline and unethical treatment. Chapter Four concludes hospital staff’s manipulation of patients and patients’ dilemmas in medical institution and then reiterates the significance of the patient-centered treatment.