For a variety of reasons, the AIDS epidemic is forcing a thorough reassessment of many of the standards by which the terminally ill and other medical patients are treated by health-care systems throughout the world. This has generally been a good thing. It has provided needed motivation for public policy-makers to take seriously a range of health-care issues that have often been downplayed, ignored, or debated with vigour only within the relatively mute pages of the academic journals of health-care professionals, (...) philosophers, law professors and others. Issues such as euthanasia, testing for dangerous communicable diseases, palliative care, and even important general questions about the distribution and availability of health-care resources have been pushed toward the front of the public health-care agenda largely because of the impact of AIDS. And it is fair to say that these matters are often being addressed with an urgency and sensitivity that would be absent without the political impetus that was unleashed along with this disease. One of the most controversial issues that has arisen concerns access to experimental therapies by the terminally ill. As is the case in other areas, the political forces generated by the AIDS tragedy have created an opportunity for productive review of policies and practices that undoubtedly deserve scrutiny and reform. However, my aim in this paper is to urge caution on some of the advocates of reform. I will argue that many recent proposals to enhance access to experimental therapies by the terminally ill rest on philosophically unsupportable grounds and pose an unjustifiable threat to the public interest in finding safe and effective therapies for terminal illnesses. (shrink)

The dissertation defends a teleological liberal normative theory against the most prominent contributions to contemporary liberal thought, specifically the deontological liberalism of John Rawls and those who have followed in the spirit of his work. The teleological theory that is advanced incorporates an objective conception of value; hence, the reference to "ideal" liberalism to designate the position that is defended. ;Ideal teleological theories have had a prominent place in modern liberal thought in the works of T. H. Green, the new (...) liberals, and others , although as a result of the impact of Rawls's work such positions have not recently received much attention and doubts have been raised about their capacity to satisfy liberal commitments to tolerance, anti-paternalism, and liberty. The dissertation defends the liberal credentials of ideal liberalism while arguing it is in a better position to respond to some of the more forceful criticisms of contemporary Rawlsian liberalism. In particular, the dissertation argues that contemporary liberalism's commitment to a resourcist conception of value, or to "liberal neutrality," cannot be sustained against criticisms about the fairness of this account of value to certain non-individualistic ways of life and against criticisms about its capacity to ensure a stable, progressive social environment. These criticisms point to the need to adopt a neo-Aristotelian conception of value as the basis of a liberal normative theory. It is also argued that a liberal theory that is based in such a conception of value is better able than its main competitor to address issues related to justice, gender, and culture. A chapter is also devoted to restoring a traditional liberal commitment to liberty as a predominant value in liberal theory by defending a normative conception of liberty in response to contemporary liberal skepticism that there is an important role for liberty in normative moral or political theory. Although the dissertation is not an exercise in the history of ideas, it draws importantly on the work of earlier ideal liberals such as J. S. Mill, T. H. Green, L. T. Hobhouse, and J. A. Hobson. (shrink)