Healthcare systems have an ethical duty to ensure equal access to high-quality healthcare as a matter of social justice. In their pursuit of that duty, they generate substantial environmental harms. For that reason, healthcare systems also have an ethical duty to minimise their environmental impacts as a matter of environmental justice and ecological justice. Many countries are already transitioning to less environmentally harmful healthcare. This study investigates whether the two duties come into tension when designing new green hospitals and how such tensions (if found to eventuate) are navigated in practice. We conducted case study research in collaboration with an Australian hospital network, with one of the network’s new public hospital builds comprising our case of focus. We undertook semi-structured interviews between March and June 2023 with those responsible for making design decisions in relation to the new public hospital being built. We analysed interview data thematically and report three main themes: separating the clinical and the environmental; tensions; and addressing tensions. We conclude by providing analysis of what is at stake in identified tensions using theories of justice, offering lessons that can help other hospitals mitigate against such tensions arising, and considering whether and when the moral reasoning employed in the case-under-study should be used to navigate the tensions. This study provides those responsible for green hospital design with a better understanding of what tensions they are likely to encounter between health, social, and environmental goods and how to reduce those tensions’ occurrence. That understanding will help them to identify and avoid such tensions in their practice, but further work is needed to develop ethical guidance on how they should navigate the tensions when they occur.

Health systems contribute to the environmental crisis. Yet, addressing this problem seems to generate a resource allocation dilemma for hospitals: investing in healthcare delivery seems to mean sacrificing environmental goods, and vice versa. We question this zero-sum thinking. After presenting the benefits of investing in the two seemingly competing goods-environmental goods and health goods-we propose that the apparent dilemma arises due to a tendency to think in dualisms. Consequently, health and environmental goods seem, respectively, to correspond to opposing sides of four dualisms: human/nature, local/global, present/future and therapy/prevention. We argue, instead, that a relational frame that considers the human person in their relational context should be used to approach the problem. A relational understanding of the human person as a meaning-making subject in relationship to all that is shows us that choosing between either health goods or environmental goods is frequently a false dichotomy: both can serve the well-being of human beings adequately understood. Such an approach, then, widens our conception of health and healthcare to include environmental goods. This wider conception of health and healthcare means that hospitals should (1) look for co-benefits in the first instance when allocating resources, thereby often resolving zero-sum thinking that gives rise to the competing goods dilemma, and (2) in the remaining cases where co-benefits are not achievable, use classic resource allocation principles, such as proportionality of benefits and burdens, to reach allocation decisions about a now wider range of goods (i.e., health and environmental, rather than merely health goods).

OBJECTIVES:There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD.DESIGN:The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory.SETTING:The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities.PARTICIPANTS:Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers.RESULTS:PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma.CONCLUSIONS:The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.

Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of human persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity.

The use of voluntary assisted dying as an end-of-life option has stimulated concerns and debates over the past decades. Although public attitudes towards voluntary assisted dying (including euthanasia and physician-assisted suicide) are well researched, there has been relatively little study of the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. Using a mix of computational textual mining techniques, keyword study and qualitative thematic coding to analyse public submissions to a parliamentary inquiry into voluntary assisted dying in Australia, this study critically examines the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. The analysis identified complex and potentially contradictory ethical principles being invoked on both sides of the debate. These findings deepen our understanding of the moral basis of public reasoning about end-of-life matters and will help to inform future discussions on policy and law reform. The findings underscore the importance of sound normative reasoning and the use of caution when interpreting opinion polls to inform policy.

Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in times of critical care resource shortages. Dignity affirms the worth of the human individual as a meaning-making embodied subject, who is always in relationship to others, the world, time, and transcendence, and who realizes their dignity through their moral behaviour. Such an understanding means people should be helped to make morally right decisions about their own treatment, which may include forgoing potentially beneficial treatment for the good of others. Respect for dignity does not require fulfilling the morally wrong choices of one who insists on treatment at the expense of others. Dignity also protects the discretion of clinicians to make decisions appropriate to their competence by prohibiting the application of broad-based criteria such as age.

Since the end of World War II, most guidelines governing human research seem to have relied on the principle of respect for autonomy as a key, though not sole, criterion in assessing the moral validity of research involving human participants.1 One explanation for this apparent reliance on respect for autonomy may be that respect for autonomy, made effective through the practice of obtaining informed consent, functions as a useful proxy when dealing with competent adults for the more complex principle of respect for human dignity that underpins much of the moral discourse in this area. If this explanation holds, then assessment of the moral licitness of research involving human individuals whose autonomy is limited in some way requires a deeper analysis of the 'thicker' concepts of human dignity, since we cannot rely on respect for autonomy to do the work of respect for human dignity where autonomy (understood as a capacity to consent based on adequate information) is not present, is limited or is compromised.

This chapter examines the explicit and implicit roles that the concept of beneficence plays in the guidelines that govern biomedical research involving humans. We suggest that the role beneficence is actually playing in the guidelines is more comprehensive than is commonly assumed. The broader conceptualisation of beneficence proposed here clarifies the relationship of beneficence to respect for autonomy. It does this by showing how respect for autonomy is at the service of beneficence rather than in tension with it.

In the debates concerning the ethics of human enhancement through biological or technological modifications, there have been several appeals to the concept of human dignity, both by those favouring such enhancement and by those opposing it. The result is the phenomenon of 'dignity talk', where opposing sides both appeal to the concept of human dignity to ground their arguments resulting in a moral impasse. This article examines the use of the concept of human dignity in the enhancement debates and reveals that the problem of dignity talk arises because proponents of various positions tend to ground human dignity in different features of the human individual. These features include species-membership, possession of a particular capacity, a sense of self-worth, and moral behaviour. The article proposes a solution to this problem by appealing to another feature of human beings, namely their being-in-relationship-over-time. Doing so enables us to understand dignity as a concept that affirms the worth of human individuals as complex, multidimensional wholes, rather than as isolated features. Consequently, the concept of human dignity can serve both a descriptive and a normative function in the enhancement debates. At a descriptive level, asking what advocates of a position mean when they refer to human dignity will reveal what aspects of being human they deem to be most valuable. The debate can then focus on these values. The normative function, although it cannot proscribe or prescribe all enhancement, approves only those enhancements that contribute to the flourishing of human individuals as multidimensional wholes.

The claim that human dignity is universal is challenged by the particular experience of the horrible things people do to others. If dignity is just a `vacuous concept' then the notion of universal human rights and the claim of cosmopolitanism that all human beings form a single moral community are also called into question. A close reading of the Universal Declaration of Human Rights and an analysis the historical development of the text reveals a complex conception of human dignity as expressed by the Component Dimensions of Human Dignity model. The model conceives of human dignity in terms of four Component Dimensions-existential, behavioral, cognitive-affective and social-each consisting of a Complementary Duality comprising two facets held in tension along an axis of the Already and the Not Yet. Consequently, human dignity can be understood both as Already a universal truth, and as Not Yet realized in every particular life.

Human dignity is a contested concept in contemporary moral discourse. One of the causes of this is the varying claims concerning the ground of human dignity, including religious and non-religious grounds. Consequently, some scholars have called for the dismissal of the concept of human dignity. Others, however, seem to be attempting to resacralize the concept of human dignity by arguing that the only legitimate ground is a religious one. This article argues that the reason that the concept of human dignity has been so successful in expanding the moral circle is because of a conscious attempt to secularize the concept in the drafting of the UN Universal Declaration of Human Rights. This secularized conceptualization has found support in post-war developments in Roman Catholic Social Teaching. The resacralization is, therefore, contrary to both the secular and Roman Catholic understandings that have developed in the second half of the twentieth century. Furthermore, it does not present an adequate solution to the problem of dignity talk because it ignores the reason the drafters of the Universal Declaration opted for a secularized understanding of human dignity in the first place.