______

Personalism in Medical

Paul Schotsmans

Medical ethics enjoyed a remarkable degree of The personalist approach to biomedical ethics continuity from the days of Hippocrates until its presents itself as a typical European reaction to the long-standing traditions began to be supplanted, or rapid changes in medicine and health care. Some at least supplemented, around the middle of the call it, however, a kind of renewal of the old twentieth century. Scientific, technological, and Thomistic approach, whereby the concept of social developments during that time produced `nature' has been replaced by the more dynamic rapid changes in the biological sciences and in concept of `'. In that way has health care. These developments challenged many been situated by many observers as a `person' prevalent conceptions of the moral obligations of centred tradition which focuses on the health professionals and society in meeting the rational nature of the human person as the moral needs of the sick and injured (Beauchamp & norm of nature. This gives the impression that Childress, 1994, 3). The Anglo-American textbook personalism is only a very `static' variant of the of Beauchamp and Childress (Principles of natural law approach. I would, however, defend the Biomedical Ethics, 1979) became the referential opinion that personalism offers a very dynamic and work for the discipline of `bio-ethics'. The authors creative approach to the complexities of recent are convinced that a long history of ancient, developments in biomedicine. In what follows, I medieval and modern health care reflection remains will illustrate this by clarifying two basic very disappointing from the perspective of dimensions of the integration of personalism in contemporary biomedical ethics: “It shows how biomedical ethics: the personalist approach offers a inadequately, and with what measure of insularity, relational foundation for medicine as a healing problems of truthfulness, privacy, justice, profession (originating in the healing relationship communal responsibility and the like were framed between physician and patient) and it presents an in past centuries (Ibidem)”. They defend(ed) the ethical framework for the integration of new four principles approach to biomedical ethics, an developments in medicine. First, however, I would approach which somewhat disparagingly has been like to situate the importance of this theoretical called principlism. reflection for medical ethics. The influence of their work has been so strong that bio-ethics seemed to become overwhelmed by 1.Moral Theories as Part of the importance of their contribution. It even created an Ethical Reflection Process a large separation between Anglo-American approaches in bio-ethics (also including the UK Before clarifying these options it remains indeed centres) and the European-Continental approach worthwhile to refer to the process of ethical re- (more linked to such basic philosophical main- flection to situate the importance of ethical theory, streams as the Aristotelian, Thomistic and Kantian also in biomedical ethics. It may be helpful in this traditions and the more recent influence of context to take advantage of the three-fold phenomenology and existentialism). In any case, distinction made by the German philosopher Max contemporary biomedical ethics incorporates Scheler: practical morality, ethos and ethics theoretical conflicts of considerable complexity, (Scheler, 1916, 1973). Following his approach was and the diverse theories make it no easier. the mainstream of one of the most important Dutch

______Ethical Perspectives 6 (1999)1, p. 10

______

personalist authors in biomedical ethics, namely these evolutions. Paul Sporken (1979), also a student of Louis Janssens. His approach remains very powerful and offers an adequate ethical method to present an integrated ethical reflection in the context of medicine. Sporken wants biomedical ethics to start where everything really begins, namely in medical practice and clinical reality itself. Descriptive methods (as used in sociology, epidemiology, statistics and so on) help us to understand so-called `practical morality'. In medi- cine, all this can be easily translated in the de- scription of the `state of the art': what are at the moment of reflection the scientific and clinical facts? To start every ethical reflection with this analysis is at the same time giving the priority to medical experience and expertise, which of course is not only that experience being shared by physicians, but also by patients or clients, nurses and others participating in medical practice. In the debates on organ transplantation, reproductive technology, human genetics, end of life decisions and so on, this requires the description, under- standing and awareness of the scientific and clinical evolutions in medicine. This work has to be reserved for medical scientists and the physicians themselves: biomedical ethics therefore cannot function without their participation. At the same time, this is a guarantee for an integrated ethical reflection. In this way, an ethical process will never neglect the basic data of medicine. The second stage is a little bit more difficult to grasp: Scheler spoke about the `ethos', which symbolizes the moral sensitivities functional within a particular culture concerning a medical reality. Valuations, intuitions or even subjective `feelings' and ideas about a particular ethical dilemma must indeed be clarified. When this more subjective side is not brought under the light of an ethical clarification, the unconscious presuppositions may remain hidden and block a rational ethical reflection. Let us take the example of the rapid changes in human genetics, like presymptomatic testing and pre-implantation genetic diagnosis. Societies, cultures and nations react differently to

______Ethical Perspectives 6 (1999)1, p. 11

______

While citizens in the United States seem easily to integrate these evolutions, this is clearly not the case in Germany, where historical memory functions as a warning sentinel for possible abuses. A hermeneutic clarification of these anxieties and of the barriers to an open debate is crucially impor- tant to make an open dialogue possible. It is therefore necessary to have time and attention for these emotions, intuitions and sensitivities in order to have an idea about how to integrate them in the ethical process. Finally, the third phase in the ethical process brings us to the core activities of the ethical re- flection: a fully rational, philosophical and even- tually theological reflection on the practical mo- rality and on the ethos must take place. This part of the process incorporates both previous stages wherein we try to clarify the values and norms which are part of the problem situation we are analyzing. Some consider this stage as a radically neutral enterprise, whereby all references to nor- mative theories must be banned or may only be indicated, without using them as a matrix for problem-solving. Others (including myself) are convinced that this is the moment for the normative dimension of the ethical process: by the integration of an ethical model, principle or hierarchy of principles or by referring to a specific anthropology, values and disvalues are propor- tionally balanced in order to find the best possible way to realize the normative orientations. It may be clear that this third stage is at the same time the battlefield of the ethical debate: normative positions may be very different and are certainly very divergent concerning medicine and healthcare.

It is here that we need to present personalism as one of the competing normative theories. Many ethical models, like , deontology and teleology, are possible.

______Ethical Perspectives 6 (1999)1, p. 12

______

As Beauchamp and Childress correctly observe, Although there is currently no perfect or even there are also divergent conceptions as to how such best moral theory, several good theories are avail- theories should be related to biomedical practice. able for medical ethics. Utilitarianism (a label Thus, who agree on a particular type of affixed to theories holding that actions are right or ethical theory may still find themselves in sharp wrong according to the balance of their good and disagreement regarding how to relate their theory to bad consequences), Kantianism or obligation-based the treatment of particular moral problems (1994, theory (a theory that some features of actions other 111). In any case, these normative theories and than, or in addition to consequences make actions ethical models function as a theoretical framework right or wrong), character ethics (or : for ethical decision making in biomedicine. emphasizes the agents who perform actions and Presenting personalism as an adequate ethical make choices), liberal (rights-based model implies at the same time a radical critique of theory: statements of rights provide vital the principlist approach: the `Georgetown mantra' protections of life, liberty, expression and (Jonsen, in: Du Bose, 1994, XIV) lacks a sound property), (views everything ethical basis to function adequately for consistent fundamental in ethics as deriving from communal ethical decision making. This is not something new: values, the common good, social goals, traditional European medical ethicists (essentially those who practices, and the cooperative virtues), ethics of were not British) remained from the early care (relationship-based accounts: caring in these beginnings of the breakthrough of bioethics very accounts refers to care for, emotional commitment reluctant to integrate this principlism into their to, and willingness to act on behalf of persons with ethical reflection. There is perhaps only one whom one has a significant relationship), casuistry exception, namely some Dutch bioethicists who — or case-based reasoning (focuses on practical in the context of the peculiar ethos of Dutch society decision-making in particular cases) and principle- — largely integrated this kind of approach. For the based, common morality theories are proposed in majority of the continental European approach to Beauchamp and Childress' latest edition on bioethics, however, it remained a weak and even biomedical ethics (44-111). narrow instrument to cover the complexities of Personalism seems, however, to belong to an ethical reflection in biomedicine (later also joined ethical model which doesn't appear on their list, in the Anglo-American literature, cfr. Davis, 1995, namely the teleological approach. The willingness 85-105; Du Bose et al., 1994). to realize the humanly desirable (as the telos or goal of our actions) is the driving force of the personalist 2. Personalism as a `Teleological' Model ethical model. According to the teleological model, an act is good if the gain aimed at outweighs the In general, an ethical theory is an approach by damage incurred (Knauer, 1998, 71). Our moral which we justify a particular ethical decision. It is a judgment of the action in question can therefore means by which we organize complex information only take place if this conditioned state is taken into and competing values and interests and formulate account and the goods, which may be in an answer to the question: what should I do? The competition with each other, are carefully main purpose of a theory is to provide consistency examined. It is true that man is unconditionally and coherence in our decision making. That is, an called on by the absolute ground of all morality. As ethical theory or framework gives us a common a contingent being, however, he is only able to means to approach various problems. If we have a realize the absolute good in the goods, which, as theory, we don't have to figure out where to begin contingent goods or values, are `relative' values and each time we meet a new problem (Shannon, 1997, as such can never be identified a priori as the third edition). greatest and highest value which can never be in

______Ethical Perspectives 6 (1999)1, p. 13

______

competition with a higher value (Böckle, 1980, therefore bound to be accepted as obligatory (or 236-7). With Ricoeur we may call this the most prohibited) without exception or as an absolute. humanly possible, which we try to realize again and The norms are valid insofar as they express what is again (Ricoeur, 1975). general or universal and insofar as they include the This implies that the moral evaluation of an act necessary conditions and take them fully into is only possible concerning the whole action. account. They express a moral norm that is valid ut Personalists suggest that a concrete, material norm in pluribus (Böckle, 237). concerns a whole series of actions which are comparable in so far as they have a similar material 3. The Fundamental Disposition: content. Even when that material content involves a The Relational Foundation premoral disvalue, the whole action can be morally right, when we have a proportionate reason for Personalism in the context of medical ethics admitting or causing the premoral disvalue. In other presents a foundational clarification of the funda- words, it is impossible to make a moral judgment mental disposition of the medical profession. It is about the material content of an action, without easy to make a link here to the so-called `relational considering the whole act: material content (actus ', with Martin Buber (1923) and, even externus, what is done), the situation, or, more, Emmanuel Levinas (1974) as inspiring classically, the circumstances and the foreseeable influences. I propose an integration of their consequences. A judgment about moral rightness or approach for the deepening of the clinical com- wrongness is only possible with respect to that mitment of the physician to his patient. The med- totality, because only concerning that whole is it ical profession is indeed a relational profession, full possible to argue whether or not it expresses the of commitment and devotion to the patient. A priority of the lesser premoral disvalue or of the framework for ethical decision-making needs this higher premoral value. If, in addition, we evaluate deepening explicitation. the moral goodness or badness of the action, we Briefly, we can present the approach of Levinas must answer the question of whether motivations as follows (Burggraeve, 1985): “the face of the and intentions result from a morally good Other signifies the fact that I am touched by a being disposition or not (Janssens, 231). Such an not in the indicative but in the imperative. Levinas approach has been called `teleological': the explains this starting point from the weakness and principal argument is based on the assumption that vulnerability of the Other which is, in a most the goods and values that form the foundation of eminent and at the same time most painful manner, our actions are exclusively conditioned, created and expressed in his mortality. By the powerless and therefore limited goods. Our moral judgment of the helpless `humility' of the poor, widowed, orphaned, action in question can therefore only take place if marginal or proletariat, (and in the case of this conditioned state is taken into account and the medicine: of the sick and ill patient) the Face, by its goods, which may be in competition with each appearance, invites the I, which strives after other, are carefully examined (Böckle, 236). happiness and power, to reduce the Other to the I's This means that there can be no doubt about the self. As a being stripped and threatened, the Face relevance of obligatory goods and values or about dares me, as it were, to do it violence. Yet there is universally obligatory norms. If norms are called something very peculiar about this `attraction to universally obligatory, this does not in any sense violence' coming from the Face. mean that they are so for all times in exactly the same way, nor does it mean that a particular form of behaviour is independent of every possible condition that is imposed on it and that it is

______Ethical Perspectives 6 (1999)1, p. 14

______

The very moment that the I is seduced into seizing In another way, Sokolowski described the same the Other in its `smallness', it experiences and foundational ethical disposition: “In acting `feels' that which it actually can do, in principle, it according to his art the physician also seeks the must not do. This is — according to Levinas — good of the patient. Because the art of medicine precisely the core of the ethical experience. The I aims at something that is a good for the patient, the feels shocked in its self-sufficiency. It discovers doctor, in the exercise of his art, seeks the medical itself in the unprotected eyes of the Face as the good of the patient as his own good. The nature of Other's potential murderer. Yet, at the same time, it his art...makes him, in the good exercise of his art, also realizes that this is absolutely forbidden. not only a good doctor but also essentially a good Levinas can rightly conclude that this is the first, moral agent, one who seeks the good of another voiceless, word of the Other: You shall not kill. formally as his own. The doctor's profession From this it becomes clear that the Face is not only essentially makes him a good man, provided he is marked by the humility of its misery (humilité) but true to his art and follows its insistence equally by the eminent elevation of the prohibition (Sokolowski, 1989, 269).” which is written in the appearance of the Face Medical practice, however, regularly demands itself. The Other is not only weakness but also very concrete ethical decision-making, whereby strength, although this denotes an ethical rather personalism again offers a clear and helpful model. than a physical or psychological power. This resistance is ethical since it appeals to the Freedom 4.Personalism as an Ethical Frame of Reference of the I. As a radical alterity, it demands an for Medical Decision-making unconditional respect from me. Yet as a defenceless poverty, it cannot compel me to give this respect by Personalism presents itself as `an ethical frame of means of physical or psychological force. While reference', so that those who are working in the turning to me, the Face asks me to come to its aid. context of personalism can develop an ethical By the powerlessness of its Face, the absolute de- evaluation and structure their human practice in mand becomes a cautious plea. The appeal of the light of this evaluation and their understanding of Face, without a doubt, signifies a call to responsi- the implications in concrete human realities. For bility for the Other (123-4).” some outsiders, it may of course add to the already This relational approach is in my view very existing confusion. For those who practise this line helpful for a foundational, even metaphysical of reasoning, it gives coherence and it offers an description of the medical relationship. As Leon R. integration of several traditions in moral Kass described this: “Medicine calls you to and moral philosophy. intrinsically self-manifesting and self-fulfilling Personalism suggests that it is essentially impor- activity, in which your good and the patient's good tant to clarify the development of some anthropo- coincide. In each daily encounter with your logical options, which then can be used for the patients, you will serve yourself exactly in your formation and function of the human conscience. efforts to help others, as you energetically respond By this, it is crucial to make clear that the reality of to the call for help, exercising your art that makes the human condition is much broader than what help possible. If one regards the patient only as some may consider the absolute reign of autonomy. objectified body, then one may take care of the By their very being, human persons are involved, patient, but one does not yet care for the patient fully intersubjective and social. (Kass, 1991)”.

______Ethical Perspectives 6 (1999)1, p. 15

______

This observation may help us to avoid falling into Here lies the contemporary anthropological the one-sidedness of the radicalization of foundation of human labour: the individual makes autonomy, which is so typical of the principlist the self a project and puts everything in motion to approach. Personalism presents a multidimensional realize this project. Furthermore, the initial insight model, which at the same time refers to the human clearly saw that every human being is different, a person in all his dimensions and relationships. Ac- unique and proper self, a person with unique cording to this vision, to be human is both to talents, capacities, feelings and possibilities. In exhibit and to participate in the wonder of a rich interaction with socio-cultural surroundings, ev- many-sidedness: to be human is to be rich in erything comes to be integrated towards the for- unicity and originality, but at the same time, mation of a unique, original personality with an originality is an empty concept if it does not individual character. include openness toward the other and if it does not The discovery of the uniqueness of being human involve cooperation with others for the expansion was so profound that in the beginning it was formu- of a solidary community. lated absolutely and radically. This might begin to explain how things have gone awry, moving toward 4.1. The Human Person: Unique and Original an egotistical fixation on the concept of autonomy. Nevertheless, the reflection on what it means to be There was a period in which little if any attention human did not stop here. Existentialist philosophy was given to the mystery of the unique human — as this movement is usually called — has had a being. Attention was focused mainly on human great influence on the spirit of our age. Yet the one- knowledge or, more broadly, human consciousness. sidedness with which the uniqueness of each However, the radical experience of the First World human being was stressed itself led to the appearan- War opened the eyes of many European ce of a counter-movement. In medical ethics, the philosophers. Suddenly, they discovered the unique critique of principlim has only very recently made and concrete human person with his or her own clear that it would be pernicious to base ethical life-project, his or her fears and expectations. It was reflection solely on the right to self-determination, discovered that the individual only becomes a self as this concept of the human person is frequently by searching for his or her own identity. This is not translated. egotism: the care for one's own being preserves the On the one hand, we should not be afraid of individual from being completely absorbed in the voicing an appreciation for the fundamental insight world of the "they" in which one is obliged to of existentialism: the originality of each personal sacrifice the uniqueness of being human to the experience of being human. On the other hand, whole of societal conventions and customs. however, it appears necessary to search for a com- plementary approach, one which is not limited to The being-human of each unique person — so the the unique, but isolated, experience of being an insight was clarified further on — is an attempt to individual. realize oneself in freedom. The individual con- structs the self with a view toward meaningful 4.2. The Human Person: existence. With the knowledge of what one is and Relational and Intersubjective what one can become, one puts everything into the service of one's own project of life. To grasp the whole of this mystery, we must con- sider as well the openness of each human being toward his fellow humans.

______Ethical Perspectives 6 (1999)1, p. 16

______

As early as 1923, the Jewish philosopher, Martin phenomenon of living in a particular, concrete Buber, wrote his pioneering work, I and Thou. society as such, and the ethical assignment that With this most valuable contribution, a new insight accompanies social living for realizing the good broke through: one can never be a human being on life. The investigation of the mystery of our being- one’s own. As humans, we essentially stand in an human here encounters a new, fascinating open relation, involved with the reality in which we discovery. For a long time, social commitment live, with other humans to whom we owe our remained outside the scope of the majority of existence and who continue to surround us, and anthropological reflection. It is not surprising that ultimately with . His insights were radicalized this insight broke through because of the contrast and re-translated by the French philosopher (also of experience of human beings confronting a social a Jewish background) Emmanuel Levinas, stressing order that was largely inhuman. The excesses of the even more strongly the radical alterity of the other. industrial revolution (in the preceding century) and The ethical relationship is interpreted as a of the dog-eat-dog relations between totalitarian relationship in which the other offers himself or states (in this century) functioned like a scream, herself to me in their being-other. Thus they no heard by those who were committed to humanity. longer subject themselves to a meaning relative to Therefore, it was primarily the victims of social my attitude to them. What is most proper to the desperation who gave voice to the task of solidary countenance of the other is that it appeals to me, responsibility (cf. the Frankfurt School with T.W. hence the ethical appeal: to what extent do I permit Adorno and M. Horkheimer). myself to be appealed to by the other? This might explain why those who accept such The insights of Buber and Levinas are not only an approach go about designing an ideal image of a crucial for the clarification of the fundamental just society. Yet, no matter how one presents it, it disposition of the medical profession, they also will never be possible to fabricate a perfect society. present clear value orientations for daily medical The most one can hope for is a movement toward practice: the physician-patient relationship must the approximation of an ideal of justice, to come as therefore be fully developed. Reproductive close to it as imaginable. It will always remain technology, for instance, should not be isolated possible to point out imperfections. Or, to express it from this relational commitment of partners to each in the terms of Emmanuel Levinas, even in the best other and of parents to their children. The same welfare state the public servant does not see the may be clear for the care of the dying patient. tears of the individual (1962). And so we come to The limitation of this dialogical philosophy the implied concept of permanent revolution which mainly lies in the fact that it overstresses the small is so particular to this approach: again and again scale and the intimate encounter. However what has already been achieved, or the already important this may be, this dialogical philosophy is existent situation, constantly needs to be questioned only valuable if it is supplemented by an analysis of and reoriented toward the more humane. The the uniqueness of every human being (cf. above) biblical condemnation of building images here and of one's solidary responsibility for a just society takes on a new significance: the truth about (cf. below). humankind and society can only be understood as a permanent process of critical transcendence of the 4.3.The Human Person already existent and the already accomplished: Communication and Solidarity societas semper reformanda. Theologically, it has been mainly political The insight into the fullness of being human is theology that has made this shift in anthropological again enlarged by the notion of participation in the questioning. whole of the society. We refer here to the

______Ethical Perspectives 6 (1999)1, p. 17

______

I would like to draw attention here to a model that 4.4. The Personalist Criterion in my opinion has proven to encompass a greater ethical range and is therefore more usable, namely With these three fundamental value orientations in Karl-Otto Apel’s model of communicative ethics mind we can articulate a moral criterion, with a (1973; cf. Schotsmans, 1988). From what was said personalist meaning: we say that an act is morally above, it has already become clear that for the first good if it serves the humanum or human dignity, time in the history of anthropological reflection, that is, if it in truth is beneficial to the human human beings have been explicitly placed before person adequately considered in these three basic the task of assuming responsibility in solidarity. value-orientations (dimensions and relationships): Individual and relational ethics are no longer uniqueness, relational commitment and solidarity. sufficient. The central question remains: how can In virtue of the historicity of the human person personal decisions in the conscience of a unique this criterion requests that we again and again person express and integrate this connection with a reconsider which possibilities we have at our responsibility in solidarity? With his model of disposal at this point in history to serve the pro- communicative ethics, Apel is more or less trying motion of the human person. That is a demand of a to reconcile these two poles. He therefore reflects dynamic and teleological ethics which summons us on the way that people communicate with each to the imperative of what is better or more human other. In speaking, taking a position, or defending a according as its actualization becomes possible. In line of argumentation, one always does this in conjunction with this we must, in our acts, respect respect to others. If not, one's argumentation makes the originality of all as much as possible. no sense. Even one who attempts to go about The three basic value orientations may be made reflection entirely on one's own cannot escape from more explicit by several types of value this. One who reflects can only articulate and verify clarifications and by the expression of these value thoughts in the form of a dialogue, even if it is a options in concrete moral norms. The personalist dialogue of the with itself. All creatures that approach requires then essentially an adequate can speak therefore have to be introduced into the proportionate balancing of these values and norms conversation — the ultimate justification of in order to promote the most humanly possible in thinking can exclude neither a partner nor any light of the most humanly desirable. potential contributions from participants to the discussion. The coexistence of humankind is thus 5. Medical challenges for personalism in practice always an existence in communication. The ethical norm behind all this demands that not only Several current topics in bioethics have been assertions but also the claims of people over and approached from the perspective of a personalist against people must be justified in dialogue. model: reproductive technology, human genetics, The societal dimension of medicine was for a organ transplantation, end of life decision-making, very long time extremely neglected. The recent palliative care, euthanasia and others. Some debates about choices in healthcare make clear applications even lead to a kind of personalist however that biomedical ethics has also taken up medicine, something that can be illustrated in a few this challenge. The personalist model, with the examples. integration of the value of solidarity — besides subjectivity and intersubjectivity — offers a com- prehensive anthropological approach.

______Ethical Perspectives 6 (1999)1, p. 18

______

In Vitro Fertilization (IVF) is a reproductive symbolically expressed in the relational gift of technology that opened up quite a lot of new organs to fellow human beings. Respect for indi- medical possibilities: a personalist reflection vidual conscientious decision-making is expressed considers an ethical integration possible, when in the possibility which is foreseen to opt out of the three conditions are fulfilled, all three referring to system (without any punishment), when one the basic normative orientations: the quality of the believes in conscience that one is not prepared to relationship between man and woman as caring share organs with other human beings (Schotsmans, parents for the future child (the dimension of the 1988). relationship); a minimal protection of the human The respect for the dying is in a personalist embryo (the respect for the unique originality of perspective another crucially relational challenge: a every human being) and a societal quality control humane accompaniment of the dying is not possible on the applicaton of the technique and the unless the relationship between the dying person integration of this medical opportunity in a and his or her bystanders is taken with the utmost democratic society (Schotsmans, 1998a). seriousness. Dying may become a really human Concerning Pre-Implantation Genetic Diagnosis process when it is lived through as an interhuman (PGD), the most important criterion remains the event, which implies a radical critique of the fundamental disposition upon which the choice for principle of autonomy as basis for medical PGD is made. Essentially this should always be a decision-making concerning the end of life service to couples who have been confronted with (Schotsmans, 1992, 1995). serious genetic risks in their family and want to prevent further problems in the future. Although it Conclusion is clear that PGD creates many ethical problems, it must also be obvious that it offers concrete problem Personalism as it has been described creates an solving for couples confronted with serious risks of ethical and even pedagogical framework for the genetic abnormalities for their children. A careful medical profession, medical practice and medical balancing of values and disvalues in concrete decision-making. The promotion of the humanly clinical cases can help to integrate ethically the desirable provides three challenges for medicine: possibilities of PGD in such a way that this the creative development of the medical profession integration promotes the humanly possible, even as a fully relational commitment; the creative though we know that it remains impossible to development of a full responsibility for the patient realize the humanly desirable (Schotsmans, 1998c). in all his dimensions and relationships and the Organ transplantation is not only a debate on its creative participation in a good society, where own, but also creates a societal need for the justice reigns. Finally, such an approach inspires to development of regulatory mechanisms. An opting do justice to the sick, the elderly and dependent out system has been justified by a typically patients. And isn't that what it is all about? personalist approach: the ontological and basic solidarity between the citizens of a country is

References

T.L., BEAUCHAMP, & J.F. CHILDRESS, Principles of Biomedical Ethics. Fourth Edition, Oxford, Oxford University Press, 1994 (1979, 1983, 1989). BÖCKLE, F., Fundamental Moral Theology. Dublin, Gill and Macmillan, 1980. BUBER, M., Ich un Du. Leipzig, Im Insel-Verlag, 1923. BURGGRAEVE, R., Emmanuel Levinas. The Ethical Basis for a Human Society. Leuven, Peeters / Centre for Metaphysics

______Ethical Perspectives 6 (1999)1, p. 19

______

and Philosophy of God, Institute of Philosophy, 1981. BURGGRAEVE, R., From Self-Development to Solidarity. An Ethical Reading of Human Desire in its Socio-Political Relevance According to Emmanuel Levinas. Leuven, Peeters / Centre for Metaphysics and Philosophy of God, 1985. DUBOSE, E.R., R.P. HAMEL & L.J. O'CONNELL (Eds.), A Matter of Principles? Ferment in U.S. Bioethics. Valley Forge (Pennsylvania), Press International, 1994. JANSSENS, L., `Norms and Priorities in a Love Ethics' in Louvain Studies 6(1976-1977), p. 207-238. KASS, L.R., `The Care of the Doctor' in Perspectives in Biology and Medicine 43(1991), p. 553-60. KNAUER, P., `A Good End Does Not Justify an Evil Means-Even in a Teleological Ethics' in J. SELLING (Ed.), Personalist Morals. Essays in Honor of Professor Louis Janssens. Leuven, University Press, 1988, p. 71-85. LEVINAS, E., `Transcendance et hauteur' in Bulletin de la Société française de philosophie 56(1962), p. 89-113. LEVINAS, E., Autrement qu'être ou au-dela de l'essence. Den Haag, 1974. RICOEUR, P., `Le problème du fondement de la morale' in Sapienza 28(1975), p. 313-337. SCHELER, M., Der Formalismus in der Ethik und die materiale Wertethik. Halle, 1916: Eng. transl. Formalism in Ethics and Non-Formal Ethics of Values. Evanston, Northwestern University Press, 1973. SCHOTSMANS, P., `Responsible Involvement and Conscientious Freedom: A Relational Approach to Medical Ethics' in J. SELLING (Ed.), Personalist Morals. Essays in Honor of Professor Louis Janssens. Leuven, University Press, 1988, p. 167-184. SCHOTSMANS, P., `When the Dying Person Looks Me in the Face…' in Ballière's Clinical Anaesthesiology 6(1992), p. 177-191. SCHOTSMANS, P., `Admission to and Removal from Intensive Care: A Personalist Approach' in K.WM. WILDES (Ed.), Critical Choices and Critical Care. Dordrecht, Kluwer Academic Publishers, 1995, p. 127-143. SCHOTSMANS, P., `In Vitro Fertilisation: the Ethics of Illicitness? A Personalist Approach' in European Journal of Obstetrics & Gynecology and Reproductive Biology 81(1998), p. 235-241. SCHOTSMANS, P., `Ownership of the Body: A Personalist Perspective' in H.A.M.J. TEN HAVE & J.V.M. WELIE (Eds.), Ownership of the Human Body. Philosophical Considerations on the Use of the Human Body and its Parts in Healthcare. Dordrecht, Kluwer Academic Publishers, 1998, p. 159-172. SCHOTSMANS, P., `Connecting Lines from an Ethical Point of View' in D. MIETH & E. HILDT (Eds.), In Vitro Fertilisation in the 1990s. Towards a Medical, Social and Ethical Evaluation. Aldershot, Ashgate, 1998, p. 301-310. SELLING, J. (Ed.), Personalist Morals. Essays in Honor of Professor Louis Janssens. Leuven, Leuven University Press, 1988. SHANNON, T.A., An Introduction to Bioethics. Third Edition Revised and Updated. New York, Paulist Press, 1997 (1979, 1987). SOKOLOWSKI, R., `The Art and Science of Medicine' in E.D. PELLEGRINO, J.P. LANGAN & J.C. HARVEY, Catholic Perspectives on Medical Ethics. Dordrecht, Kluwer Academic Publishers, 1989, p. 263-275. SPORKEN, P., Ethiek en gezondheidszorg. Baarn, Ambo, 1979.u

______Ethical Perspectives 6 (1999)1, p. 20