The revival of virtue ethics over the last thirty‐five years has produced a bewildering diversity of theories, which on the face of it seem united only by their opposition to various features of more familiar Kantian and Utilitarian ethical theories. In this paper I present a systematic account of the main positive features of virtue ethics, by articulating the common ground shared by its different varieties. I do so not to offer a fresh defence of virtue ethics, but rather to (...) provide a conceptual map that locates its main claims and arguments in relation to those of rival theories, and identifies its distinctive contribution to contemporary ethics. I set out six specific claims which are made by all forms of virtue ethics, and I explain how these claims distinguish the theory from recent character‐based forms of Kantian ethics and Utilitarianism. I then use this framework to briefly survey two main strands of virtue ethics which have been developed in the literature.1. (shrink)

In many recent discussions of the morality of actions where both good and bad consequences foreseeably ensue, the moral significance of the distinction between intended and foreseen consequences is rejected. This distinction is thought to bear on the moral status of actions by those who support the Doctrine of Double Effect. According to this doctrine, roughly speaking, to perform an action intending to bring about a particular bad effect as a means to some commensurate good end is impermissible, while performing (...) an action where one intends only this good end and merely foresees the bad as an unintended sideeffect may be permissible. Consequentialists argue that this is a distinction which makes no moral difference to the evaluation of the initial act in the two cases, given that the overall consequences are the same in each case. In this paper we aim to show that a standard consequentialist line of argument against the moral relevance of the intention/foresight distinction fails. Consequentialists commonly reject the moral relevance of this distinction on the grounds that there is no asymmetry in moral responsibility between intending and foreseeing evil. We argue that even if this claim about moral responsibility is correct, it does not entail, as many Consequentialists believe, that there is no moral asymmetry between acts of intended and foreseen evil. We go on to argue that those consequentialists who do concede the moral relevance of the intention/foresight distinction at the level of agent evaluations cannot consistently make such a concession, and that such a position is in any case untenable, because it entails a complete severance of important conceptual connections between act and agent evaluations. (shrink)

Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a (...) rigorous articulation and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)

Introduction In recent years there has been a welcome reawakening of philosophical interest in the emotions. A significant number of contemporary ...

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...) more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

Originally published in 1992 this book attacks many recent philosophical and psychological theories of the emotions and argues that our emotions themselves have intrinsic moral significance. He demonstrates that a proper understanding of the emotions reveals the fundamental role they play in our moral lives and the practical consequences that arise from being morally responsible for our emotions.

This chapter contains sections titled: The Rise of Virtue Ethics Essential Features of Virtue Ethics Virtue Ethics Approaches to Bioethics Criticisms of Virtue Ethics Conclusion References Further reading.

In this article we argue that the worries about whether a consequentialist agent will be alienated from those who are special to her go deeper than has so far been appreciated. Rather than pointing to a problem with the consequentialist agent's motives or purposes, we argue that the problem facing a consequentialist agent in the case of friendship concerns the nature of the psychological disposition which such an agent would have and how this kind of disposition sits with those which (...) are commonly thought proper to relations of friendship. To the extent that we are right, then, the rejoinders which indirect consequentialists have offered to the problem of alienation are ill directed and so do not succeed in meeting the real problem. In articulating what we see as the source of the alienation problem which friendship poses for consequentialism, we also hope to clarify the general distinction between dispositions and motives and to show how certain kinds of guiding internalized normative dispositions help us to define and therefore distinguish between various types of relationships. Undertaking this task may also help to identify some of the crucial issues for an adequate moral psychology of friendship and its place in any plausible ethical theory. (shrink)

In this issue of the Hastings Center Report, Ann Hamric, John Arras, and Margaret Mohrmann highlight how contemporary accounts of the virtue of courage in health care often gloss over deeper problems in the underlying health care systems themselves. They express particular concerns about the appropriateness and personal costs of exhortations to health professionals to take courageous action in circumstances where this is “required only because of unethical institutional structures” (p. 39). They offer valuable points that are not adequately recognized (...) in discussions of courage as a professional virtue in health care practice. The call for more judicious appeals to health professionals to exercise courage in health care practice should clearly be heeded. A sole reliance on practitioner courage for exposing unethical workplace practices would be misguided. Nevertheless, there is still a legitimate place for encouraging health professionals to develop and act on courage. (shrink)

The standard problem with many slippery slope arguments is that they fail to provide us with the necessary evidence to warrant our believing that the significantly morally worse circumstances they predict will in fact come about. As such these arguments have widely been criticised as ‘scare-mongering’. Consequentialists have traditionally been at the forefront of such criticisms, demanding that we get serious about guiding our prescriptions for right action by a comprehensive appreciation of the empirical facts. This is not surprising, since (...) consequentialism has traditionally been committed to the idea that right action be driven by empirical realities, and this hard-headed approach has been an especially notable feature of Australian consequentialism. But this apparent empirical hard-headedness is very selective. While consequentialists have understood their moral outlook and commitments as guided by a partnership with empirical science – most explicitly in their replies to the arguments of their detractors – some consequentialists have been remarkably complacent about providing empirical support for their own prescriptions. Our key example here is the consequentialist claim that our current practises of partiality in fact maximise the good, impartially conceived. This claim has invariably been made without compelling support for the large empirical claims upon which it rests, and so, like the speculative empirical hand-waving of weak slippery slope arguments, it seems similarly to be undermined. While these arguments have presented us with ‘wishful thinking’ rather than ‘scare-mongering’, we argue in this paper that their complacency in meeting the relevant empirical justificatory burden remains much the same. (shrink)

Immanuel Kant argues in the Foundations that remote scenarios are diagnostic of genuine virtue. When agents commonly thought to have a particular virtue fail to exhibit that virtue in an extreme situation, he argues, they do not truly have the virtue at all, and our propensities to fail in such ways indicate that true virtue might never have existed. Kant’s suggestion that failure to show, say, courage in extraordinary circumstances necessarily silences one’s claim to have genuine courage seems to rely (...) on an implausibly demanding standard for warranted virtue attributions. In contrast to this approach, some philosophers—such as Robert Adams and John Doris—have argued for probabilistic accounts of warranted virtue attributions. But despite the initial plausibility of such accounts, I argue that a sole reliance on probabilistic approaches is inadequate, as they are insufficiently sensitive to considerations of credit and fault, which emerge when agents have developed various insurance strategies and protective capacities against their responding poorly to particular eventualities. I also argue that medical graduates should develop the sorts of virtuous dispositions necessary to protect patient welfare against various countervailing influences, and that repeated failures to uphold the proper goals of medicine in emergency scenarios might indeed be diagnostic of whether an individual practitioner does have the relevant medical virtue. In closing, I consider the dispositions involved in friendship. I seek to develop a principled way of determining when remote scenarios can be illuminating of genuine friendship and genuine virtue. (shrink)

We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...) of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease. We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …. (shrink)

Alberto Giubilini and Francesca Minerva reject arguments from claims that fetuses and newborn infants are potential persons, because they argue that potential persons cannot be harmed.1 But whether or not potential persons can be harmed, is it clear that potential persons are entirely lacking in moral status, of a kind that could count as a reason against bringing about their demise? We do not generally regard potential as entirely lacking in moral value until it is actualised. For example, parents who (...) believe they have identified in their child an emerging musical talent commonly see this potential as having some value, however small, which would count as a reason against destroying that …. (shrink)

The many difficult ethical issues raised by family caregiving have been thrust into prominence by recent changes to hospital funding systems which encourage earlier discharge of patients. This paper investigates the sort of involvement that health professionals might justifiably have in family caregiving arrangements. It argues that the proper role of health professionals in protecting exhausted family caregivers can be clarified by considering some analogies with arguments about justifiable breaches of patient confidentiality. The paper also argues that health professionals who (...) seek to encourage neglectful adult children to help care for their sick parents should not do so by appealing to what a health professional takes those childrens’ filial duties to be. (shrink)

The possibility of human reproductive cloning has led some bioethicists to suggest that potentiality-based arguments for fetal moral status become untenable, as such arguments would be committed to making the implausible claim that any adult somatic cell is itself a potential person. In this article I defend potentiality-based arguments for fetal moral status against such a reductio. Starling from the widely-held claim that the maintenance of numerical identity throughout successive changes places constraints on what a given entity can plausibly be (...) said to have the potential to become, I argue that the cell reprogramming that takes place in reproductive cloning is such that it produces a new individual, and so adult somatic cells cannot be potential persons. (shrink)

In this article, I respond to Alan Henderson’s critique of the quality of care argument for surgeon report cards. I discuss some significant US and UK studies demonstrating that surgeon report cards improve clinical outcomes. I also indicate that surgeon report cards are in any case supported by other important ethical arguments, such as arguments from surgeons’ professional accountability obligations, and from patients’ entitlements to be informed about the risks of surgery upon them.

This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance - surgeons' report cards - should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common (...) objections to the use of report cards on the clinical performance of surgeons. (shrink)

In light of controversy surrounding the initial online publication of Alberto Giubilini and Francesca Minerva's article on ‘After-birth abortion: why should the baby live?’ in the Journal of Medical Ethics,1 ….