The pluralism that democratic regimes foster creates the following serious problem in societies: When people disagree so fundamentally about the good life, where are the grounds of social unity to be found? This is a quite general problem for liberal political theory, but in this chapter I want to focus on a related but narrower set of issues having to do with what justice requires with respect to the provision of health care in modern democratic societies.

Despite an explosion of studies on memory in historical and cultural studies, there is relatively little in moral philosophy on this subject. In this book, Jeffrey Blustein provides a systematic and philosophically rigorous account of a morality of memory. Drawing on a broad range of philosophical and humanistic literatures, he offers a novel examination of memory and our relations to people and events from our past, the ways in which memory is preserved and transmitted, and the moral responsibilities (...) associated with it. Blustein treats topics of responsibility for one's own past; historical injustice and the role of memory in doing justice to the past; the relationship of collective memory to history and identity; collective and individual obligations to remember those who have died, including those who are dear to us; and the moral significance of bearing witness. (shrink)

The theme of this book is the complex moral psychology of forgiving and remembering in both personal and political contexts. It offers an original account of the moral psychology of interpersonal forgiveness and explores its role in transitional societies. The book also examines the symbolic moral significance of memorialization in these societies and reflects on its relationship to forgiveness.

Should the authority to make treatment decisions be extended to the competent patient's family? Neither arguments from fairness nor communitarian concerns justify such an infringement on patient autonomy.

Despite the current popularity of what is commonly referred to as an `ethics of care', no one has yet undertaken a systematic philosophical study of `care' itself. In this book, Jeffrey Blustein presents the first such study, offering a detailed exploration of human `care' in its various guises: concern for and commitment to individuals, ideals, and causes. Blustein focuses on the nature and value of personal integrity and intimacy, and on the questions they raise for traditional moral (...) theory. (shrink)

This paper is a response to particularist critics of the normative force of moral principles. The particularist critique, as I understand it, is a rejection not only of principle‐based accounts of moral deliberation and justification, but also of accounts of character in which principles play a central role. I focus on the latter challenge and counter it with a view I call character‐principlism. I begin by discussing in a general way what motivates the particularity objection to principles and then contrast (...) two views – both of which insist on the importance of attentiveness to particularity – about the relative normative status of principles and particular cases. I present some reasons for believing that we need a more normatively robust conception of the role of moral principles than the particularists provide. In the main portion of the paper, I discuss how character‐principlism sees principles functioning in our lives and the lives we lead with others. I contrast this with some other accounts of desirable character that particularists can embrace, and argue that these are seriously flawed because, unlike character‐principlism, they cannot satisfactorily explain how a person could possess the constancy of character that moral integrity requires. (shrink)

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention (...) in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician. -/- Critical to a proper appreciation of the significance of this conflict is a distinction that the literature on biomedical ethics has largely failed to draw: that between medical paternalism and physician integrity. (shrink)

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal (...) identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else. (shrink)

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal (...) identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else. (shrink)

As medical technology becomes more sophisticate the ability to manipulate nature and manage disease forces the dilemma of when can becomes ought. Indeed, most bioethical discourse is framed in terms of balancing the values and interests and the benefits and burdens that inform principled decisions about how, when, and whether interventions should occur. Yet, despite advances in science and technology, one caregiver mandate remains as constant and compelling as it was for the earliest shaman—the relief of pain. Even when cure (...) is impossible, the physician's duty of care includes palliation. Moreover, the centrality of this obligation is both unquestioned and universal, transcending time and cultural boundaries.Although universally acknowledged, pain is a complex phenomenon for both the patient and the caregiver, influenced as much by personal values and cultural traditions as by physiological injury and disease. (shrink)

In this paper, we critically appraise institutions for people with disabilities, from residential facilities to outpatient clinics to social organizations. While recognizing that a just and inclusive society would reject virtually all segregated institutional arrangements, we argue that in contemporary American society, some people with disabilities may have needs that at this time can best be met by institutional arrangements. We propose ways of reforming institutions to make them less isolating, coercive, and stigmatizing, and to provide forms of social support (...) the larger society denies many people with disabilities. Although these reforms far fall far short of abolition, they draw heavily on the work of disability scholars and advocates who call for the complete replacement of institutional arrangements with systems of supported living. The consideration of non-ideal-solutions is useful not only in reforming existing institutional arrangements, but in bringing disability scholarship and advocacy to bear on bioethics, which has paid little attention to institutions for people with disabilities. We intend this paper to redress the neglect within mainstream bioethics of the complex ethical problems posed by institutions. (shrink)

If the practice of maternal‐fetal medicine sometimes results in abortion, can a physician strongly opposed to abortion maintain his own integrity and still practice in this field?

: Urban bioethics seeks to broaden the traditional focus of bioethics to encompass questions about the interplay of individuals with family, group, community, and society. Urban bioethics will need to deal with cultural diversity, issues of equity, and the conflict between individual rights and the public good. Encouraging a multicultural ethical discernment, fostering an appreciation of the political, economic, sociological, and psychological issues that inform the question of urban moral choice, urban bioethics is essentially a multi-disciplinary, synthesizing enterprise. Several theoretical (...) models including social contract, rule utilitarian, communitarian, and feminist paradigms offer complementary conceptual frameworks. This paper is offered as a proposal, a road map for future study to place current bioethical analysis into a broader context. (shrink)

Urban bioethics seeks to broaden the traditional focus of bioethics to encompass questions about the interplay of individuals with family, group, community, and society. Urban bioethics will need to deal with cultural diversity, issues of equity, and the conflict between individual rights and the public good. Encouraging a multicultural ethical discernment, fostering an appreciation of the political, economic, sociological, and psychological issues that inform the question of urban moral choice, urban bioethics is essentially a multi-disciplinary, synthesizing enterprise. Several theoretical models (...) including social contract, rule utilitarian, communitarian, and feminist paradigms offer complementary conceptual frameworks. This paper is offered as a proposal, a road map for future study to place current bioethical analysis into a broader context. (shrink)

What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a (...) valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it. (shrink)

Suppose a primary care physician practicing in an underserved community orders a treatment for one of her indigent patients under the state’s Medicaid program.

Abstract: Forgiveness of wrongdoing in response to public apology and amends making seems, on the face of it, to leave little room for the continued commemoration of wrongdoing. This rests on a misunderstanding of forgiveness, however, and we can explain why there need be no incompatibility between them. To do this, I emphasize the role of what I call nonangry negative moral emotions in constituting memories of wrongdoing. Memories so constituted can persist after forgiveness and have important moral functions, and (...) commemorations can elicit these emotions to preserve memories of this sort. Moreover, commemorations can be a restorative justice practice that promotes reconciliation, but only on condition that the memories they preserve are constituted by nonangry negative, not retributive, emotions. (shrink)

Holding Wrongdoers Responsible contests a number of widely accepted, almost standard, claims about blame and forgiveness in the philosophical literature, and their relationship to each other.

The recent child custody case Weisberger v Weisberger raises a number of ethical issues concerning the rights and responsibilities of parents. Chavie Weisberger, thirty‐five, and her husband, both members of an ultraorthodox Hasidic community, appeared before a religious court in 2008 to obtain a divorce. There are two sharply contrasting legal rulings in this case. Setting aside the legally significant fact that Chavie had signed the divorce agreement with the clause requiring her to raise her children Hasidic, which decision is (...) ethically more defensible and why? Were Chavie's parental rights violated when the court removed her children from her care? Should her ex‐husband have been awarded full custody on the ground that this was in the children's best interest, and is this the right standard to use in making custody decisions? What parental responsibilities did Chavie and her ex‐husband have, and were they satisfactorily discharging them? A theory of the moral foundations of parenthood should provide answers to these questions among others. Joseph Millum, in his excellent new book The Moral Foundations of Parenthood, does this and more. His theory encompasses accounts of the foundation and content of parental rights and responsibilities, the acquisition of parental responsibilities, and the standards governing parental decision‐making. (shrink)

This essay is written in the belief that questions relating to the treatment of impaired and imperiled newborns cannot be adequately resolved in the absence of a general moral theory of parent-child relations. The rationale for treatment decisions in these cases should be consistent with principles that ought to govern the normal work of parenting. The first section of this paper briefly examines the social contract theory elaborated by John Rawls in his renowned book A Theory of Justice and extracts (...) from it normative principles that can guide us in our attempt to lay a rational foundation for parenthood. The second section clarifies the implications of a Rawlsian theory for the problem at hand by examining several standards that have been proposed for the treatment of impaired newborns: the strict right-to-life standard, the medical decision standard, and the quality-of-life standard. A Rawlsian standard, by contrast, is autonomy-based. That is, it would have us base our treatment decisions on consideration of the child's capacity for developing critical rationality in making decisions on his or her own. This standard, it is suggested, avoids morally objectionable features of the others. (shrink)

RÉSUMÉ: J'examine ici trois façons de défendre l'idée que les personnes ont individuellement une valeur. Je pars de la thèse selon laquelle la valeur des individus tient à la valeur de leurs qualités particulières. Je m'arrête alors sur l'objection que pour comprendre ce qui fait la valeur individuelle des personnes, il nous faut accorder une place distinctive à leurs conceptions d'elles-mêmes. L'approche par la conception de soi qui résulte de ces considérations se révèle problématique à l'examen, mais elle nous oriente (...) vers une façon «kantienne», plus satisfaisante, de rendre compte de la valeur des individus. L'explication en question développe la doctrine des «deux points de vue» avancée par Christine Korsgaard et fait reposer ma valeur en tant qu'individu sur la dignité qui est la mienne en tant que maître d'œuvre de ma propre vie, un titre que personne d'autre ne peut avoir. (shrink)

RÉSUMÉ: J'examine ici trois façons de défendre l'idée que les personnes ont individuellement une valeur. Je pars de la thèse selon laquelle la valeur des individus tient à la valeur de leurs qualités particulières. Je m'arrête alors sur l'objection que pour comprendre ce qui fait la valeur individuelle des personnes, il nous faut accorder une place distinctive à leurs conceptions d'elles-mêmes. L'approche par la conception de soi qui résulte de ces considérations se révèle problématique à l'examen, mais elle nous oriente (...) vers une façon «kantienne», plus satisfaisante, de rendre compte de la valeur des individus. L'explication en question développe la doctrine des «deux points de vue» avancée par Christine Korsgaard et fait reposer ma valeur en tant qu'individu sur la dignité qui est la mienne en tant que maître d'œuvre de ma propre vie, un titre que personne d'autre ne peut avoir. (shrink)

The maxim “parents should do what is in the best interests of their child” seems like an unassailable truth, and yet, as I argue here, there are serious problems with it when it is taken seriously. One problem concerns the sort of demands such a principle places on parents; the other concerns its larger social implications when conceived as part of a national policy for the rearing of children. The theory of parenting that creates these problems I call “optimizing parentalism.” (...) To avoid them, I define and defend a new and more morally appealing theory, “satisficing parentalism.”. (shrink)