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Bioethics in Denmark: Moving from First- to Second-Order Analysis?



This article examines two current debates in Denmark—assisted suicide and the prioritization of health resources—and proposes that such controversial bioethical issues call for distinct philosophical analyses: first-order examinations, or an applied philosophy approach, and second-order examinations, what might be called a political philosophical approach. The authors argue that although first-order examination plays an important role in teasing out different moral points of view, in contemporary democratic societies, few, if any, bioethical questions can be resolved satisfactorily by means of first-order analyses alone, and that bioethics needs to engage more closely with second-order enquiries and the question of legitimacy in general.



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1. Blendon, RJ, Kim, MK, Benson, JM. The public, political parties, and stem-cell research. New England Journal of Medicine 2011;365:1853–6.

2. Eurobarometer. Social values, science and technology [special report]; 2005. (last accessed 18 March 2014).

3. Schelde N, Vaaben L. Helt uenige om aktiv dødshjælp: Folket er for, politikerne imod. (last accessed 13 May 2013).

4. For a short introduction, see the council’s Web site, available at (last accessed 13 May 2013).

5. See, e.g., Global Gini index (Distribution of family income) ranking by country. (last accessed 15 May 2013).

6. These figures are based on the 2013 data from the Danish tax ministry.

7. There is an advisory board concerning expensive in-hospital drugs, Rådet for Anvendelse af Dyr Sygehusmedicin, but the function of this board is, as implied by the name, mainly consultative.

8. Danish Council of Ethics. Ethics and prioritization in the health sector: Why is it so difficult?; available at∼/media/bibliotek/misc/2013/Etik-og-prioritering-i-sundhedsvaesenet-hvorfor-det-er-saa-svaert.pdf (last accessed 16 May 2013).

9. Gaus, G. The Order of Public Reason. Cambridge: Cambridge University Press; 2011, at 446.

10. See Danish Council of Ethics. Det Etiske Råds Udtalelse om eventuel lovliggørelse af aktive dødshjælp; available at (last accessed 18 march 2013).

11. See note 10, Danish Council of Ethics, at 8ff.

12. See note 10, Danish Council of Ethics, at 16–18.

13. Nothing important follows from whether we take voluntary euthanasia or assisted suicide as an example, or so we believe.

14. This seems unreasonable at least given some standard qualifications and conditions. It is not necessarily unreasonable to expect a person with a perfectly good life, several years of expectedly good quality ahead, and good mental and physical health not to end her own life, or so we would argue.

15. See, e.g., Rietjens, JAC, van der Maas, PJ, Onwuteaka-Philipsen, BD, van Delden, JJM, van der Heide, A. Two decades of research on euthanasia from the Netherlands: What have we learnt and what questions remain? Bioethical Inquiry 2009;6:271–83. doi:10.1007/s11673-009-9172-3.



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