A Clone of your Own provides a short, lucid, and very readable introduction to the science of human cloning and some of the central ethical issues surrounding it.The attractive 162 page pocket sized book is interspersed with original and often quirky drawings by David Mann. These drawings, as well as a good number of well chosen and sometimes equally quirky contemporary and archival photographs, provide context and texture and even a sense of wonder to the scientific and ethical discussion. In (...) addition, the author—US lawyer and bioethicist Arlene Klotzko—draws on a rich background of literary, cinematic, and cultural sources. She shows that certain fears associated with reproductive human cloning—such as the loss of personal identity and predictions about the disastrous consequences of hubristic attempts by humans to “play God” by forming humans in their image—have a long history and have given rise to a contemporary genre captured by terms, such as “Frankenscience”.Klotzko has an easy writing style and the ability to convey both complex scientific information, as well as the gist of ethical debates, to the lay reader. Serious discussion is interspersed with personal anecdotes, and the reader soon …. (shrink)

Perkin and Resnik advocate the use of muscle relaxants to prevent the “agony of agonal respiration” arguing that this is compatible with the principle of double effect. The proposed regime will kill patients as certainly as smothering them would. This may lead some people to reject the argument as an abuse of the principle of double effect. I take a different view. In the absence of an adequate theory of intention, the principle of double effect cannot distinguish between the intentional (...) and merely foreseen termination of life, and cannot rule out end-of-life decisions that are often regarded as impermissible.What Perkin and Resnik are in effect saying is that there are times when physicians have good reasons to end a patient’s life—deliberately and intentionally—for the patient’s sake. Why not say so—instead of going through the agony of trying to match sanctity of life and patient-centred medical care? (shrink)

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed (...) to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed. (shrink)

In earlier publications, we had argued that Paul Ramsey is inconsistent because he simultaneously asserts that (i) 'all our days and years are of equal worth' and (ii) 'that it is permissible to refrain from prolonging the lives of some dying patients'. Thomas Long has suggested that we have not shown that Paul Ramsey is inconsistent. Ramsey and we, he holds, start from incommensurable metaphysical views: for Ramsey, the dying process has religious significance--God is calling his servant home. While it (...) is normally a good thing to keep a patient alive, it would, for Ramsey, show deafness to God's call to keep a dying patient alive. It is true we do not share Paul Ramsey's religious views. It is, however, not necessary to rely on any particular metaphysical views to refute Ramsey's position. For Ramsey's view to be internally consistent, Ramsey would have to be able to distinguish between dying and non-dying patients. We examine some of Ramsey's examples and show that his practical judgements do not allow us to draw this distinction. This means that, contra Long, we hold fast to our charge that Ramsey's view is inconsistent. (shrink)

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of (...) potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. (shrink)

The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of (...) someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it. (shrink)

How are we to decide where our scarce medical resources are most effectively spent? The notion of a quality-adjusted-life-year has been proposed as a way of doing this. Some economists appear to think that this can be done without making ethical assumptions. We examine the application of this notion to the treatment of premature newborns, and especially to comparisons between the value of medical care for newborns, and the value of medical care for older people. We find that some highly (...) questionable ethical assumptions are inovled in such comparisons. (shrink)

Harris argues that if QALYs are used only 50% of the population will be eligible for survival, whereas if random methods of allocation are used 100% will be eligible. We argue that this involves an equivocation in the use of "eligible", and provides no support for the random method. There is no advantage in having a 100% chance of being "eligible" for survival behind a veil of ignorance if you still only have a 50% chance of survival once the veil (...) is lifted. A 100% chance of a 50% chance is still only a 50% chance. We also argue that Harris provides no plausible way of dealing with the criticism that his random method of allocation may result in the squandering of resources. (shrink)

Thomas Long has argued that there is an irreconcilable metaphysical difference between the views of those who, like ourselves, believe that on quality-of-life grounds it is sometimes justifiable to end the life of a severely handicapped infant, and those who, like Paul Ramsey, reject this view. Because of this metaphysical difference, Long considers it impossible for our arguments to refute Ramsey's position. We disagree.

Since 1989 there has been an ongoing controversy about the limits of public discussion of bioethical issues in the German-speaking world. While a number of scholars have been involved, Peter Singer and Helga Kuhse have been the principal targets of those seeking to limit bioethical debates. Those who have supported silencing discussion of certain issues have argued that such public discussion leads to a loss of freedom. In the article we argue that toleration is not based on subjectivism but (...) rather on reason. Furthermore, the efforts to suppress debate are often based on a failure to understand our position. Such efforts at suppression also rest on an elitist view of society that must assume that the general public cannot debate such topics. (shrink)

Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies.Design and participants: Cross-sectional postal survey of doctors in Victoria.Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the (...) definition of euthanasia.Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. (shrink)

This volume contains all that the beginning reader or student needs to soundly grasp the ideas and issues involved in the field. Building on the model used by Peter Singer in his highly successful "Companion to Ethics, the "Companion to Bioethics" consists of 46 specially written essays designed to present the key issues and concepts in bioethics in an authoritative yet always readable, non-technical manner. An unusually comprehensive index allows the reader to find terms and topics not listed in the (...) titles of the essays themselves. "A Companion to Bioethics" is an essential work of reference for doctors, nurses, lawyers, journalists, philosophers, moral theologians, sociologists and everyone interested in the ethical issues that are transforming our lives. It will be applicable both to everyday health care practice, and to the far-reaching issues arising from the revolution in the biological sciences as applied to human ethics. (shrink)

Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down's syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down's syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex (...) issues involved. This volume--by two authorities on medical ethics--presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic. (shrink)

The philosophical debate over the moral difference between killing and letting die has obvious relevance for the contemporary public debate over voluntary euthanasia. Winston Nesbitt claims to have shown that killing someone is, other things being equal, always worse than allowing someone to die. But this conclusion is illegitimate. While Nesbitt is correct when he suggests that killing is sometimes worse than letting die, this is not always the case. In this article, I argue that there are occasions when it (...) is better to kill than to let die. (shrink)

ABSTRACT If a doctor kills a severely handicapped infant, he commits an act of murder; if he deliberately allows such an infant to die, he is said to engage in the proper practice of medicine. This is the view that emerged at the recent trial of Dr Leonard Arthur over the death of the infant John Pearson. However, the distinction between murder on the one hand and what are regarded as permissible lettings die on the other rests on the Moral (...) Difference Myth, according to which deliberate lettings die in the practice of medicine are not instances of the intentional causation of death. I argue that a doctor who refrains from preventing a handicapped infant's death, causes that infant's death and does so intentionally. He commits an act of murder. But, I suggest, not all instances of the intentional causation of death are morally wrong. To the extent that they are not, killing rather than letting die will often be the preferable option because more economical of suffering. Hence what is required is the abolition of the Moral Difference Myth and legislation to the effect that those doctors who justifiably cause a patient's death—whether by an action or by an omission—commit no offence. (shrink)

In Abortion and Infanticide, Michael Tooley argues that it is not wrong to destroy potential persons, such as fetuses and newly born infants. His argument presupposes the following: 1)that the destruction of potential persons is not directly wrong because potential persons do not have a right to life; 2)that destroying a potential person—a fetus or an infant—is morally the same as preventing the existence of an possible person by, for example, using a contraceptive or refraining from, intercourse during a woman's (...) fertile period; and 3)that it is not wrong to prevent the existence of additional persons who are likely to lead happy or satisfying lives. Here I am concerned with the third presupposition. On this presupposition, the prima facie permissibility of abortion and infanticide hinges on the “moral neutrality” of those of our reproductive decisions on which the existence of additional people depends. (shrink)

According to the "sanctity-of-life" view, all human lives are equally valuable and inviolable, and it would be wrong to base life-and-death medical decisions on the quality of the patient's life. Examining the ideas and assumptions behind the sanctity-of-life view, Kuhse argues against the traditional view that allowing someone to die is morally different from killing, and shows that quality-of-life judgments are ubiquitous. Refuting the sanctity-of-life view, she provides a sketch of a quality-of-life ethics based on the belief that there (...) is a profound difference between merely being alive and life being in the patient's interest. (shrink)

We examine the view that all human life is of equal worth or sanctity. We find that this view is a legacy of the Judeo- Christian tradition, and cannot be justified in non - religious terms. We therefore argue that it should be rejected, and that we should openly acknowledge that some Jives are of less worth than others. We then consider a common objection: that this will lead us down a slippery slope to Nazi- style atrocities. We give our (...) reasons for finding this objection unpersuasive. We explain why no-one has any grounds for feeling threatened by our proposal. Finally we discuss who should make the decision involved in selecting whether a person should come into existence, and how that decision should be carried out. (shrink)

This volume provides a critical introduction to contemporary attempts to base nursing ethics on a feminine 'ethics of care'.

This article presents an empirical study of approaches to ethical decision-making among nurses and doctors. It takes as its starting point the distinction between the perspectives of care and of justice in ethical thinking, and the view that nurses' thinking will be aligned with the former and doctors' with the latter. It goes on to argue that the differences in these approaches are best understood in terms of the distinction between partialist and impartialist modes of moral thinking. The study seeks (...) to determine the distribution of these modes of thinking between nurses and doctors, and finds that there are no signif icant differences between them. A 'two-level' philosophical view of the nature of moral thinking is appealed to in order to explain the study findings. (shrink)

This second edition of _A Companion to Bioethics,_ fully revised and updated to reflect the current issues and developments in the field, covers all the material that the reader needs to thoroughly grasp the ideas and debates involved in bioethics. Thematically organized around an unparalleled range of issues, including discussion of the moral status of embryos and fetuses, new genetics, life and death, resource allocation, organ donations, AIDS, human and animal experimentation, health care, and teaching Now includes new essays on (...) currently controversial topics such as cloning and genetic enhancement Topics are clearly and compellingly presented by internationally renowned bioethicists A detailed index allows the reader to find terms and topics not listed in the titles of the essays themselves. (shrink)

What proportion of available healthcare funds should be allocated to hip replacement operations and what proportion to psychiatric care? What proportion should go to cardiac patients and what to newborns in intensive care? What proportion should go to preventative medicine and what to treating existing conditions? In general, how should limited healthcare resources be distributed If not all demands can be met?

: In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overridden. Although severely demented patients are morally (...) considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment. (shrink)

The expanded and revised edition of _Bioethics: An Anthology_ is a definitive one-volume collection of key primary texts for the study of bioethics. Brings together writings on a broad range of ethical issues relating such matters as reproduction, genetics, life and death, and animal experimentation. Now includes introductions to each of the sections. Features new coverage of the latest debates on hot topics such as genetic screening, the use of embryonic human stem cells, and resource allocation between patients. The selections (...) are independent of any particular approach to bioethics. Can be used as a source book to complement _A Companion to Bioethics_. (shrink)

Now fully revised and updated, Bioethics: An Anthology, 3rd edition, contains a wealth of new material reflecting the latest developments. This definitive text brings together writings on an unparalleled range of key ethical issues, compellingly presented by internationally renowned scholars. The latest edition of this definitive one-volume collection, now updated to reflect the latest developments in the field Includes several new additions, including important historical readings and new contemporary material published since the release of the last edition in 2006 Thematically (...) organized around an unparalleled range of issues, including discussion of the moral status of embryos and fetuses, new genetics, neuroethics, life and death, resource allocation, organ donations, public health, AIDS, human and animal experimentation, genetic screening, and issues facing nurses Subjects are clearly and captivatingly discussed by globally distinguished bioethicists A detailed index allows the reader to find terms and topics not listed in the titles of the essays themselves. (shrink)

Impartialism in ethics has been said to be the common ground shared by both Kantian and utilitarian approaches to ethics. Lawrence Blum describes this common ground as follows: Both views identify morality with a perspective of impartiality, impersonality, objectivity and universality. Both views imply the ‘ubiquity of impartiality” – that our commitments and projects derive their legitimacy only by reference to this impartial perspective.